Regional anesthesia for scapulothoracic fixation surgery: Anatomic review and case series.

Scapulothoracic fixation surgery is a surgical intervention used for symptom relief in patients who suffer from scapular dysfunction. To date, there are few reports on the use of regional anesthesia for pain control in patients undergoing this procedure. The nerve supply of the scapula and surrounding tissues is complex and arises from both cervical and thoracic nerve roots. We suggest the use of a combined technique for perioperative pain control in patients undergoing scapulothoracic surgery. After a review of the relevant anatomy, we present four cases using combined regional techniques for postoperative pain control. The techniques utilized include thoracic paravertebral blocks with shoulder blockade, resulting in satisfactory pain control.

Care for the Obstetric Patient with Complex Cardiac Disease.

The prevalence of cardiac disease-related maternal morbidity and mortality is on the rise in the United States. To ensure safe management of pregnancy in patients with cardiovascular disease, pre-delivery evaluation by a multidisciplinary Pregnancy Heart Team should occur. Appropriate anesthetic, cardiac, and obstetric care are essential. Risk stratification tools evaluate the etiology and severity of cardiovascular disease to determine the appropriate hospital type and location for delivery and anesthetic management. Intrapartum hemodynamic monitoring may need to be intensified, and neuraxial analgesia and anesthesia are generally appropriate. The anesthesiologist must be prepared for obstetric and cardiac emergencies.