Anesthesia Related Outcomes in Patients Receiving Regional Anesthesia for Shoulder Surgery in a CRNA-Only Practice In the Rural Setting

  • Greg Bozimowski, DNP, CRNA University of Detroit Mercy
  • Peter Skellenger, MS, CRNA University of Detroit

Abstract

The purpose of this retrospective chart review was to characterize the complication rate and outcomes among a group of patients receiving regional anesthesia (RA) undergoing shoulder surgery in the rural setting utilizing a Certified Registered Nurse Anesthetist (CRNA) only model. Demographic information was obtained. Patients were primarily ASA 2 and 3 classifications and were outpatients with a mean age of 52.6 years. The most common preoperative diagnosis was rotator cuff tear. The recorded procedure was most often shoulder arthroscopy. RA was performed on 70 patients (92.1%) with 6 (7.9%) patients receiving no RA. General anesthesia (GA) was administered with RA to 68 (89.5%) patients with the remainder receiving sedation with RA. Pain scores as measured by visual analogue scale (VAS) reflected effective analgesia. The mean VAS score reported on arrival to PACU was 1.27, after one hour 1.69, and 0.38 upon discharge from PACU. Postoperative analgesics were required for 26 (34.2%) patients. The incidence of postoperative nausea or vomiting was 6.6% of patients reporting nausea and 2.6% patients experiencing emesis. The mean anesthesia time was 127.3 minutes with mean operating room time of 121.2 minutes. Mean time in PACU was 134.6 minutes. The descriptive data attained in the analysis demonstrate RA as a safe and effective supplement to GA administered by CRNAs in a rural setting. Future research is needed specific to CRNA-only practice models and rural settings and should include controlled randomized trials to evaluate outcomes in groups consisting of GA, GA+RA, RA + sedation and even RA alone in select populations.

Author Biographies

Greg Bozimowski, DNP, CRNA, University of Detroit Mercy

Associate Professor, University of Detroit Mercy Graduate Program of Nurse Anesthesiology. I am licensed as a registered nurse and certified as a nurse anesthetist. I hold a BSN from Wayne State University- Detroit MI, A MS in nurse anesthesia from Mercy College of Detroit and a Doctor of Nurse Practice from the University of Detroit Mercy.

Peter Skellenger, MS, CRNA, University of Detroit

Peter Skellinger was a student at the University of Detroit Mercy at the time of writing the manuscript.  He is now a practicing CRNA in MI

References

1. American Hospital Association Website. AHA research policy page. The Opportunities and Challenges for Rural Hospitals in an Era of Health Reform http://www.aha.org/research/policy/2011.shtml accessed June 4th, 2015.

2. Ozzeybek D, Oztekin S, Mavioglu O, et al. Comparison of the haemodynamic effects of interscalene block combined with general anaesthesia and interscalene block alone for shoulder surgery. The Journal of International Research. 2003; 31: 428-433.

3. Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia. 2010; 65: 608-624.

4. Abdallah FW, Halpern SH, Aoyama K, Brull R. Will the realbenefits of single-shot inter-scalene block please stand up? A systematic review and meta-analysis. Anesthesia & Analgesia. 2015; 120(5) 1114-1129.

5. Hadzic A, Williams BA, Karaca PE. et al. For Outpatient Rotator Cuff Surgery, Nerve Block Anesthesia Provides Superior Same-day Recovery over General Anesthesia. Anes-thesiology. 2005; 102:1001–1007.

6. Lehmann L, Loosen G, Weiss C, Schmittner M. Interscalene plexus block versus general anaesthesia for shoulder surgery: A randomized controlled study. Eur J Orthop Surg Traumatol. 2015; 25(2) 255-61. doi: 10.1007/s00590-014-1483-3. Epub 2014 May 15. Accessed June 4th, 2015

7. Yauger, Y, Bryngelson J, Weiss C, et al. Patient outcomes comparing CRNA-administered peripheral nerve blocks and general anesthetics: A retrospective chart re-view. AANAJ. 2010.78(3) 215-220.

8. Gonano C, Kettner SC, Ernstbrunner M, Schebasta K, Chiari A, Marhofer P. Comparison of economical aspects of interscalene brachial plexus blockade and general anesthesia for arthroscopic shoulder surgery. British Journal of Anaesthesia. 2009; 103 (3): 428–33 (2009) doi:10.1093/bja/aep173. Accessed June 4th, 2015.

9. Gohl MR, Moeller RK, Olson RL, Vacchiano CA. The addition of interscalene block to general anesthesia for patients undergoing open procedures. AANAJ. 2001. 69(2) 105-109
Published
2017-07-19
How to Cite
BOZIMOWSKI, DNP, CRNA, Greg; SKELLENGER, MS, CRNA, Peter. Anesthesia Related Outcomes in Patients Receiving Regional Anesthesia for Shoulder Surgery in a CRNA-Only Practice In the Rural Setting. Anesthesia eJournal, [S.l.], v. 5, p. 14-22, july 2017. ISSN 2333-2611. Available at: <https://anesthesiaejournal.com/index.php/aej/article/view/55>. Date accessed: 25 sep. 2017.
Section
Articles

Keywords

CRNA; CRNA-only; rural anesthesia; regional anesthesia; shoulder surgery; anesthesia outcomes.