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Anesthesia and Positioning for Arthroscopy

Interscalene regional blockade has been effective in providing early postoperative pain relief and in decreasing overall narcotic requirements following surgery . Following adequate preoperative anesthesia, the choice of patient position (either beach-chair or lateral decubitus) must be tailored to the surgeon such that comprehensive visualization and repair of the pathologic structures are not compromised.

Lateral decubitus is preferred for patients with MDI or posterior instability because this position eases access to the axillary pouch and posteroinferior capsule because of the lateral traction that is applied. The patient is positioned on a long beanbag, and the arm held in a longitudinal arm-traction device with 20 degrees of abduction and 20 degrees of flexion.

A second, laterally directed force is also applied to the proximal humerus using 2 to 5 kg of traction. If the beach-chair position is chosen for a posteroinferior labral repair, an accessory trans-rotator cuff portal may be used to enable direct visualization of the postero-inferior glenohumeral joint.

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