Expert: Jennifer Evans, MSN, CRNA - 1/23/2012

Question
I am not a fan of any kind of chemical sedation for surgery.  I am 64 years old and after my mother's surgery she had severe and permanent memory loss.  I need to have rotator cuff surgery and I would like to know if a block can be done so that I will be awake and alert? If not do you know any other options that do not involve a lot of chemicals that reduce memory. Thank you for your time and expertise to answer my question.

Answer
Hi Patricia,

 Rotator Cuff Repairs (RTCR) can be done with an Interscalene Regional Block where the c5-c6 nerve root for the shoulder is blocked.  It depends on the severity of your injury and whether the tendon has been torn from the bone, as RTCRs can be quite painful even arthroscopically.  If you want to remain awake/alert you might want to consider an interscalene catheter so that the local anesthetic can be continuous as opposed to a single shot, which still lasts 12-16hours.  It may be patchy, where General Anesthesia would be a backup plan anyway.

 Most of the time preoperative interscalene blocks are used in conjunction with general anesthesia, but the block significantly cuts down on the need for narcotic pain meds during anesthesia, which can help you wake up smoother.  Avoid Benzodiazepines (Versed) for memory loss.  As far as permanent memory loss, I cannot predict a family history or a fluke event.  A low-dose infusion of Remifentanil (expensive narcotic) with an interscalene block would keep you awake and pain free. I've done deep brain electrode implantation with just a remifentanil drip and spoke with the patient throughout the case.  Some hospitals don't stock Remi, so talk with the anesthesia team during the pre-op consult and tell them your needs.  

Good luck!! Hope this helps.

-Jennifer, CRNA