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Educated Hand Publishing LLC 
“The Science Behind the Art” 
Volume 5 - No. 3 2017 

 Anesthesia eJournal - Online
ISSN 2333-2611

Page 14

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

Gregory Bozimowski DNP, CRNA1

Peter Skellenger MS, CRNA2

Affiliation:
1 University of Detroit Mercy

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

Funding/Conflict of Interest Disclosure: 
The authors have no funding or conflicts of interest to report.

INTRODUCTION
As the population in the United States ages and the demands on the healthcare system increase, so too does the pressure to 
provide superior anesthesia services that include safe, effective, efficient care with improved outcomes, greater patient satisfac-
tion, and lower cost. This is particularly the case in rural areas of the United States, which account for nearly 72 million Ameri-
cans who may have limited access to providers, where the drive to provide high quality care while reducing costs is paramount.1

Regional anesthesia (RA) for shoulder surgery is a commonly used technique. The benefits have been studied and are well 
documented. One commonly used technique is the administration of an interscalene block (ISB) to supplement the adminis-
tration of general anesthesia (GA) in combination with sedation, or even as a sole anesthetic, has gained favor. The avoidance 
or reduction of the hemodynamic instability and other adverse effects that may occur as a result of GA is one appeal to that 
practice.2 In addition, regional anesthesia has been shown to provide postoperative pain relief for patients undergoing shoulder 
procedures. While single shot ISB has been shown to provide significant postoperative pain relief, it is of a short duration and 
is not without adverse effects.3

A review of the literature was conducted to examine the potential benefits of RA as compared to GA for shoulder surgery with 
a secondary intent to evaluate the presence of data collected in rural settings. 

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 re-
mainder 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.

AEJ



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Volume 5 - No. 3 2017 Page 15

BACKGROUND
The electronic based search of the literature review was completed 
using the following databases: PubMed, Cochrane, INFOTRAC, 
MEDLINE, Ovid Medline, and CINAHL. The following sub-
ject headings and combinations were used: “interscalene + shoul-
der surgery”, “regional anesthesia vs. general anesthesia”, “regional 
anesthesia + shoulder surgery”, “regional anesthesia”, “ambulatory 
surgery”, “rural anesthesia”, “rural + anesthesia”.
The search revealed many articles that compared RA with GA; 
however, there is a lack of articles with specificity to the rural 
setting. (See Table 1- Data-Extraction) A meta-analysis by Ab-
dallah and colleagues4 reviewed randomized and quasi-random-
ized controlled trials that compared ISB to GA and combined 
techniques. The authors examined studies conducted between 
1994 and 2013 and represented 1090 patients over 23 trials. They 
reported reduced pain at rest and in motion at various intervals 
postoperatively in patients who received an ISB. The analysis also 
revealed decreased opioid consumption in the first 24 hours and 
longer time to request opioids in the ISB group. Other reported 
benefits of ISB included increased patient satisfaction, decreased 
time of stay in the post anesthesia care unit (PACU) and hospi-
tal admission and a lower incidence of postoperative nausea and 
vomiting (PONV). The authors concluded that ISB provided 
effective analgesia during the first 6 postoperative hours and 
reduced opioid related side effects. 
Hadzic and colleagues5 conducted a randomized, blinded, 
prospective study comparing the techniques of ISB to GA with 
respect to the recovery profiles and patient satisfaction in patients 
having outpatient shoulder surgery. Data were collected from 
a total of 50 patients placed equally into 2 groups consisting of 
those receiving an ISB and those receiving GA. Primary outcome 
measures included: patients eligible for bypass of phase I PACU 
instead going directly to phase II, hospital admission rates, and 
time to discharge. Secondary outcome measurements included: 
reports of moderate/severe pain, treatment of pain, nausea, vomit-
ing, sore throat, ambulation, oral intake, and time to home readi-
ness. The authors reported that more patients receiving ISB (76%) 
were eligible to bypass phase I of PACU than patients receiving 
GA (16%). No patients receiving ISB were admitted to the hos-
pital, while 16% of the GA group was admitted overnight due to 
intractable pain. Time to discharge of ISB patients was found to 
be 2.5 hours less than patients receiving GA. No patients in the 
ISB group reported moderate to severe pain as compared to 80% 
of those in the GA group. Pain score values and analgesic use 
differences between the two groups were not statistically signif-
icant; however, the authors report these findings as “statistically 
underpowered”. The authors report that patient satisfaction with 
anesthesia was higher in the ISB group with 79% reporting that 
they would choose the same anesthetic again while 36% of the 
patients in the GA group stated they would choose GA again. 
Lehmann and colleagues6 conducted a randomized controlled 
study of 120 subjects that evaluated the use of ISB versus GA, or 
a combined ISB + GA for patients undergoing shoulder arthros-
copy. The primary outcome variable measured was opioid con-
sumption on the day of surgery with secondary outcomes being 
post-op monitoring times, anesthesia times, patient satisfaction, 
and the ability to bypass the recovery room. In addition, subjec-
tive outcomes such as perceived pain and nausea were measured. 

Following surgery, the authors found that 27 of 40 subjects 
receiving ISB only were able to bypass the PACU completely 
and had the shortest monitoring time necessary in the PACU 
compared to GA or GA + ISB. On the day of surgery, opioid 
consumption was significantly reduced in the patients receiving 
ISB but they found no significant difference in opioid consump-
tion between the ISB and ISB + GA groups. Patient satisfaction 
scores in the ISB and ISB + GA groups were significantly higher 
than scores reported by GA only patients. Patients in the ISB 
group reported less nausea and vomiting as compared to the other 
groups and reported their experience as “better than expected” 
more frequently than patients in both the GA and the GA + ISB 
groups. 
In a retrospective chart review, Yauger and colleagues7 compared 
outcomes between patients undergoing either shoulder arthros-
copy or knee arthroscopy receiving GA or RA in a military same 
day surgery unit (SDSU) in a certified registered nurse anesthe-
tist (CRNA) only practice model. The study reviewed 342 cases, 
with 161 GA and 181 RA. Combined GA and RA procedures 
were excluded. Regional anesthetic techniques included inter-
scalene block (ISB) for shoulder arthroscopy or femoral nerve 
block (FNB) for knee arthroscopy. Results included a 13 minutes 
longer pre-op time for GA patients than the RA group, with a 
slightly less intra-operative time. The GA group also utilized 25.9 
minutes less anesthesia provider time. The RA group spent 20.3 
minutes less time in PACU than did the GA group and SDSU. 
Pain scores post-operatively were significantly increased in the 
GA group, with increased morphine equivalent opioid use by 
the GA group relative to the RA group. This study suggests that 
CRNA-administered regional anesthesia provided a safe and 
effective alternative anesthetic for outpatient shoulder and knee 
arthroscopy, with improved quality indicators such as a reduction 
of PONV, pain, and opioid consumption as compared to GA. 
Gonano and colleagues8 evaluated the differences between 
ultrasound (US) guided ISB and GA for arthroscopic shoulder 
surgery. The total sample size was 40 patients with equal distribu-
tion into each group. Researchers recorded all drugs and dispos-
able equipment used and evaluated each method in terms of cost. 
Other costs were calculated considering anesthesia-related work-
flow and total anesthesia time, total time in PACU, and readiness 
for discharge. A decreased total cost for patients receiving ISB 
(33 +/- 9 €) was reported as compared to the GA group (41 +/- 7 
€). The authors found that anesthesia time was significantly less 
in the ISB group [12 (+/- 4) minutes] versus the GA group [23 
(+/- 6) minutes]. PACU time was significantly reduced in the ISB 
group (45 +/- 17 min) versus the GA group (70 +/- 20) minutes. 
The review of the literature suggests that RA not only allows for 
excellent surgical anesthesia, but also reduces length of patient 
stay, intra and post-operative opioid requirements, post-operative 
pain, PONV, and overall cost, while simultaneously improving 
patient satisfaction scores. The review also demonstrates a need 
for research to explore best practices specific to rural anesthesia 
practice. 

PURPOSE OF THE STUDY
Although there is a significant body of literature comparing 
regional anesthesia to general anesthesia, there are few studies 
looking at these techniques for shoulder surgery specifically in the 



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Volume 5 - No. 3 2017 Page 16

rural population. The purpose of this retrospective chart review 
was to characterize the complication rate and outcomes among 
a group of patients receiving regional anesthesia in patients 
undergoing shoulder surgery in the rural setting utilizing a Cer-
tified Registered Nurse Anesthetist only model. Complications 
measured in this review included nausea, vomiting, and delayed 
discharge. Need for opioid analgesia was also measured.

MATERIALS AND METHODS

DESIGN
The Institutional Review Board at the University of Detroit 
Mercy approved the project through expedited review. It is a 
retrospective chart review of patients undergoing shoulder surgery 
at Hillsdale Community Health Center (HCHC) during 2014. 
HCHC utilizes a CRNA only anesthesia practice model. It has 
47 acute care beds and is located in Southwestern Michigan, 112 
miles from Detroit, in a county of approximately 47,000 people. 
The project was also approved by the administration of HCHC 
who granted access to the patient electronic records.  

DATA COLLECTION
The authors developed the data collection sheet used to gather 
patient information. (Appendix 1) Inclusion criteria included 
all patients undergoing shoulder surgery. The hospitals electron-
ic medical system was utilized to retrieve records of patients 
through coding indicating they met inclusion criteria during 
the identified time period. To maintain confidentiality and 
anonymity, patient identifiers were not collected. Collected data 
included patient demographics of gender, age, ASA status, height, 
weight, and BMI. In addition preoperative diagnosis, surgical 
approach (open versus arthroscopic), surgical procedure, and type 
of anesthetic administered were recorded. Times were measured 
reflecting anesthesia time, operating room time, and PACU time 
in minutes. The occurrence of nausea or vomiting was recorded as 
was prophylactic and rescue agents administered. Pain measure-
ments upon arrival to PACU, one hour later, and upon discharge 
from PACU were also recorded using the VAS. Opioid and other 
analgesic administration was recorded for pre, intra, and postop-
erative periods.  

RESULTS
Seventy nine patient records were reviewed. Three patient records 
were excluded because of incompleteness of crucial data in the 
records leaving a sample population of 76 patients. Descriptive 
analysis of the data was performed. Demographic data is summa-
rized in table 2. 
The most common preoperative diagnosis was rotator cuff tear 
(47.4%) followed by impingement syndrome (14.5%) and an-
kylosis (6.6%) with a variety of other diagnoses comprising the 
remainder in near equal numbers. The recorded procedure was 
most often shoulder arthroscopy (76.3%). A combined RA with 
GA technique was performed on nearly all patients so compari-
sons between RA and GA were not attainable. (Table 3) Bupiv-
icaine 0.5% was utilized in 65 (85.5%) of the RA procedures with 
ropivicaine 0.5% utilized in the remainder. Only 3 patients (3.9%) 
received preoperative analgesia. Pain scores as measured by VAS 
reflected effective analgesia. (Table 4) 

The overall rate of PONV as well as rescue medication for 
PONV was low. Prophylaxis for PONV was administered to 
most patients with ondansetron 4 mg alone or in combinations 
with dexamethasone 4mg or metaclopromide 10mg most often 
utilized. (Table 5)
The mean anesthesia time was 127.3 minutes with mean OR 
time of 121.2 minutes. Mean time in PACU was 134.6 minutes. 
Blocks were administered in the preoperative holding area so 
that OR time was not prolonged. Two blocks were deemed to be 
ineffective in PACU and were re-administered. One patient was 
admitted unplanned for intractable pain. No other adverse events 
were reported. 

DISCUSSION
This analysis provided current data related to demographics 
and outcomes in patients undergoing shoulder surgery in a 
CRNA-only rural practice setting. Quality outcomes data are 
crucial to continuously provide supportive data speaking to the 
safety and efficacy of CRNA solo practice. The descriptive data 
attained demonstrates effective RA as a supplement to GA. As 
a result, a decrease in Mean Alveolar Concentration (MAC) of 
inhaled agent can be assumed and small intraoperative doses of 
opioid were required allowing a reasonable assumption of a cor-
relation to reduced opioid side effects. 
A very low incidence of PONV occurred suggesting that low 
opioid use, inhalation agent, and/or prophylactic antiemetic 
administration was effective. The PONV incidence was lower 
than reported in the studies reviewed here and lower than the 
incidence reported by Gohl and colleagues9 in a 2001 study com-
paring ISB to GA techniques in which they found 66% of GA 
patients experienced nausea and 25% for those receiving ISB and 
GA combined.
The measured mean anesthesia time represented only 6.1 minutes 
longer than OR time. So the institutional practice of performing 
the regional technique in the preoperative holding area did not 
significantly increase valuable time in the OR.
This study is not without limitations. Foremost, a randomized 
prospective design comparing GA to RA or a longer retrospective 
study period to mine data from patients who underwent shoul-
der surgery prior to the predominate practice of most frequently 
employing RA would provide better comparative data. Since the 
target population was a rural setting with CRNA-only practice 
the findings cannot be generalized to larger facilities with other 
anesthesia care models. 
This study provides supportive data that RA added to the anes-
thesia plan for shoulder surgery in a rural, CRNA-only practice 
is safe, effective and efficient. Although questions could not be 
answered through comparison of groups in this study, the data 
revealed low incidences of postoperative adverse events, effective 
analgesia during the postoperative period, and minimal anesthesia 
time beyond operating room time needed.

Implications for Clinical Practice and Future Research
The current trends in healthcare in the United States point 
towards increasing patient satisfaction and quality while reduc-
ing costs. Regional anesthesia has long been recognized as a 
safe alternative or adjunct to general anesthesia in select patient 
populations and surgical procedures. As the reviewed literature 



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Volume 5 - No. 3 2017 Page 17

suggests, a regional approach to outpatient shoulder surgery can 
reduce costs and improved outcomes, with the added benefit of 
improved patient satisfaction. Future research is needed specific 
to CRNA-only practice models and rural settings and should in-
clude controlled randomized trials to evaluate outcomes in groups 
consisting of GA, GA+RA, RA + sedation and even RA alone 
in select populations. Research exploring the potential benefits 
of the use of ultrasound-guided blocks versus more traditional 
approaches and the use of lower doses of local anesthetics and 
optimization of outcome measures need also to be conducted. 

Further, it may prove beneficial to evaluate the effectiveness 
of continuous infiltration of local anesthetic in the outpatient 
setting. An additional area of future research should include a 
focus on rural anesthesia and the costs associated with providing 
anesthetic care in this setting. This review of the current litera-
ture as well as the descriptive evaluation of this practice points 
to promising reduction of costs and increased efficiency, both 
areas that could drastically impact the bottom line in the often 
budget-compromised rural healthcare setting. 
 

Table 1-Data Extraction
Authors/Study Design, Purpose and 

Sample
Results and Conclusions Critique of Strengths  

and Weakness
Hadzic A, Williams BA, 
Karaca PE. et al. 

For Outpatient Rotator 
Cuff Surgery, Nerve Block 
Anesthesia Provides 
Superior Same-day Recovery 
over General Anesthesia. 
Anesthesiology. 2005; 
102:1001–1007.

Design: 
Prospective, randomized 
study comparing the 
use of ISB to GA for 
outpatient shoulder 
surgery. 

Purpose: 
To compare which 
technique (nerve block 
vs. GA) provides more 
efficient recovery 
and greater patient 
satisfaction.

Sample: 
50 patients 

Result:  
* 76% of ISB patients and 
16%of GA patients bypassed 
PACU

* 0 ISB patients and16% of 
GA patients were admitted

* 0 (0 %) ISB patients and 
20 (80 %) GA patients were 
treated for pain in PACU

* Discharge time for ISB was 
123 +/- 57 min and 286 +/- 
100 min for GA patients

Conclusions:  
The authors conclude that 
ISB increased PACU bypass, 
faster same-day recovery, 
better analgesia, and fewer 
adverse events following 
outpatient rotator cuff 
surgery as compared to GA. 

Strengths:  
Randomized, blinded study

Aldrete scoring used on all 
patients initially to assess 
ability to bypass PACU

Follow-up was through 2 week 
period

Weaknesses:   
Small sample size

GA patients received PONV 
prophylaxis, ISB patients did 
not

GA patients received nitrous 
oxide 50%, an agent known to 
produce PONV

 



Authors/Study Design, Purpose and 
Sample

Results and Conclusions Critique of Strengths 
and Weakness

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

Design:  
Randomized, controlled, 
clinical trial

Purpose:  
Evaluates the post-op 
opioid consumption in 
patients receiving ISB, 
ISB + GA, or GA alone for 
shoulder arthroscopy

Sample: 
120 patients total.

ISB: N= 40 
ISB + GA: N= 40 
GA: N= 40 

Result:  
* Opioid requirements 
of ISB and ISB + GA were 
similar and less than GA 
alone. 

* ISB had significantly 
higher patient satisfaction 
scores

* ISB led to significantly 
less PONV and lower pain 
scores than GA or GA + 
ISB

* ISB had increased 
rate of bypassing PACU 
and discharge from the 
recovery room than ISB 
or ISB + GA

Conclusions:  
When compared to GA, 
patients receiving ISB or 
ISB + GA had a reduction 
in post-op opioid 
consumption, time to oral 
intake and 

Strengths: 

• Randomized, blinded 
study

• Large sample sizes

Weaknesses:  

• The authors cite 
their choice of LA 
and volume of dos-
ing as a weakness of 
the study 

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Volume 5 - No. 3 2017 Page 18



Authors/Study Design, Purpose and 
Sample

Results and Conclusions Critique of Strengths 
and Weakness

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.

Design:    
Randomized clinical trial

Purpose:    
This study was designed 
to evaluate the potential 
economic advantage of 
US- guided ISB vs. GA for 
arthroscopic shoulder 
surgery. The emphasis in 
this study is placed on the 
use of ultrasound for block 
placement and the economic 
impact vs. GA.  

Sample: 
 40 patients total

ISB group: N= 20

GA group: N= 20

Result: 

* Costs are minimally lower in 
the ISB group compared to the 
GA group. Cost savings seen in 
faster turnover time when ISB 
performed in block room. 

* PACU time, opioid use, PONV 
rates all reduced in the ISB group. 

* 10% of ISB patients needed 
vasopressor and fluid therapy 
vs. 60% of GA patients. 

Conclusions: 
 ISB is a cost-effective method 
of providing anesthesia for 
arthroscopic shoulder surgery. 
ISB is associated with less total 
anesthesia related cost and 
improved time efficacy.

Strengths: 

• Looked specifically 
at costs

• Looked at 
US-guided blocks 

Weaknesses:  

• Small sample size
• Australian study- 

may not be able 
to extrapolate to 
US

Anesthesia eJournal                         www.anesthesiaejournal.com
Volume 5 - No. 3 2017 Page 19

Authors/Study Design, Purpose and 
Sample

Results and Conclusions Critique of Strengths 
and Weakness

Yauger, Y, Bryngelson J, 
Weiss C, et al. 

Patient outcomes comparing 
CRNA-administered 
peripheral nerve blocks 
and general anesthetics: A 
retrospective chart review. 
AANAJ. 2010.78(3) 215-220.

Design:  
Retrospective chart review

Purpose:  
 To compare quality 
indicators and operative 
time demands between 
patients undergoing 
shoulder or knee 
arthroscopy under GA vs. RB.

Sample:  
342 patients undergoing 
shoulder or knee 
arthroscopy, with either GA 
or RA. RA in this study refers 
to either interscalene block 
for shoulder arthroscopy or 
femoral nerve block for knee 
arthroscopy. 

Result: 

* The GA group used 25.9min 
less anesthesia provider time 
overall but spent 20.3 min 
longer in PACU than the RA 
group. 

* 15.5% of GA patients had 
PONV vs. 10.0% of RB patients, 
a statistically insignificant 
difference. 

* RA patients had a significant 
decrease in pain scores post-
operatively and used less 
opioid than the GA group. 

* 12 patients in the RA group 
bypassed the PACU, while no 
patients in the GA did.

Conclusions:  Significantly less 
opioid use and pain scores 
when RA is used over GA. 

Strengths: 

• Large sample size
• CRNA- only study
Weaknesses:  

• Only ASA 1 and 2 
patients. 

• Only GA or RB, no 
combined tech-
nique patients

• Retrospective 
study



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Volume 5 - No. 3 2017 Page 20 

Table 2 Demographics

N =76 Gender Age

Years

Weight

kg

BMI

Kg/m2

ASA

status
M = 37 (51%) - - - 1=1

Mean F = 39 (49%) 52.9 83 30.4 2= 3
Min 19 51 18.2 3= 52
Max 83 159 51.8 4=1

Table 3 Techniques

Anesthetic Airway

Adjunct

Surgical

Approach
RA+GA= 68 (90%) ETT= 65 Open= 58
GA only= 6 (8%) LMA= 3 Arthroscopy= 15
RA+ sedation= 2 (2%) - Not indicated= 3

 
Table 4 VAS Scores

N =76 VAS

Arrival

VAS

1 hr.

VAS

DC
Mean 1.27 1.69 0.37
Reported score of 0 59 (77.6%) 48 (63.2%) 59 (77.6%)

Table 5 PONV Data

Postop

Nausea

Postop

Vomiting

PONV

Prophylaxis

PONV

Rescue
5 (6.6%) 2 (2.6%) 69 (90.8%) 3 (3.9%)



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 interscalene 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. Anesthesiology. 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 review. 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

Anesthesia eJournal                         www.anesthesiaejournal.com
Volume 5 - No. 3 2017 Page 21

http://www.aha.org/research/policy/2011.shtml


Appendix 1 Data Collection Tool

Case Number (1, 2, 3 etc.):________
Demographics
Age: _______Gender:   Male ______ Female _____ 
Height (cm):  Weight (kg):      BMI (kg/m2):  ASA Status _________
Co-morbidities: _________________        
Inpatient ______   Outpatient________
Diagnosis: ________________________________________
Upper Extremity Surgical Procedure: _________________________________________________
Surgical Approach: Open incision____________          Scope________________
Type of Anesthesia
_________Regional and General Anesthesia
  Type of Block: _________________ 
  General using LMA: _____      OET: ________  
_________Regional with Sedation
Type of Block______________________
_______    General without Block
_______    Local/MAC
Comments: _______________________________________     
OR and PACU Times (minutes)
Total OR time _____Total Anesthesia time: ______ Total PACU time: ___________ 

Perioperative Data
Preoperative Pain Medications
Opioid: _____________ Amount: _____________ Route:  IV______ PO______IM_____                  
NSAID: _____________ Amount: ____________   Route:  IV______ PO______IM_____
Acetaminophen       Amount: ____________   Route:  IV______ PO______  
Other Type: ______________ Amount: _____________ Route:  IV______ PO______IM_____
Intraoperative Pain Medications
Opioid: _____________ Amount: _____________ Route:  IV______ PO______IM_____                  
NSAID: ______________ Amount: ____________ Route:  IV______ PO______IM_____
Acetaminophen       Amount: _____________ Route:  IV______ PO______
Other: ______________ Amount: _____________ Route:  IV______ PO______IM_____
Postoperative Pain Management 
Local Anesthesia Infiltrated at Incision Site (by surgeon): YES____    NO_____
Catheter placed for post op pain:  YES______   NO_______
Pain scores in PACU:
Arrival VAS _______ 
1 hour VAS_______
Pain score at discharge: VAS______
Comments: ________________________
Pain Medication Use in PACU
Opioid: ______________   Amount: _____________   Route:  IV______ PO______IM_____                  
NSAID: ______________   Amount: _____________   Route:  IV______ PO______IM_____
Acetaminophen: Amount: _____________   Route:  IV______ PO______
Other: ______________   mount: _____________   Route:  IV______ PO______IM_____
PONV and Treatment
Nausea: (Y/N) Vomiting: (Y/N)
PONV Prophylaxis given: Drug:  Dose:   Route: ____________
Rescue meds for PONV: Drug:  Dose:   Route: ____________
Complications
Delay in discharge:  (Y/N) Reason: _______________   Length of Delay: _______________
Unplanned postop hospital admission: (Y/N) Reason___________________________  _ 
Other:   ______________________________________________________      

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