Continuous Suprascapular Catheter and Axillary Nerve Block for Analgesia for Reverse Total Shoulder Arthroplasty: A Case Report.

Reverse total shoulder arthroplasty (RTSA) is a widely employed surgical intervention for managing advanced shoulder arthritis. Postoperatively, patients frequently experience intense pain, particularly within the first 48 hours. Effective pain management through regional analgesia not only facilitates a quicker hospital discharge but also minimizes the reliance on opioids. One such regional analgesic approach is the combined suprascapular and axillary nerve block, which targets the glenohumeral joint, rotator cuff muscles, and the shoulder's lateral region for effective pain alleviation. Previous research indicates that this dual nerve block method offers sustained pain relief while circumventing the respiratory complications commonly associated with interscalene brachial plexus blocks, which may inadvertently block the phrenic nerve and affect respiration. We report the case of a 75-year-old female, diagnosed with severe chronic obstructive pulmonary disease (COPD) and bronchiectasis on multiple inhalers, who presented for RTSA. The patient had a strong desire to avoid opioids for pain control due to adverse side effects. Through a suprascapular nerve catheter and axillary nerve single shot, regional analgesia was administered, which minimized the risk of respiratory complications due to potential phrenic nerve involvement from an interscalene approach. There were no opioids taken in the postoperative period after discharge, and the patient only received oral acetaminophen. The patient experienced a successful recovery without any respiratory complications and was extremely satisfied with her management.