Christopher Cook, DO
Anesthesiologist, Beaumont, Texas

My patient was a 60-year-old grandfather who needed surgery to repair his shoulder. But this wasn’t just a routine procedure. My patient had another severe health condition that made it risky for him to have the total shoulder replacement that his surgeon recommended.

My patient suffered from profound sleep apnea, which causes a person to momentarily stop breathing while asleep. As an anesthesiologist, I knew that my patient’s sleep apnea could be made significantly worse and even become life-threatening by administering general anesthesia and “morphine-like” pain medications. Although we have the education, training and expertise to intervene in a crisis during surgery, we much prefer to avoid these emergencies in the first place.

So I drew on another area of my training and expertise that’s part of an anesthesiologist’s intensive education: specialized acute pain management. During the consultation with my patient, I explained an effective alternative technique called regional anesthesia. For this type of anesthesia, I would use ultrasound guidance to perform a nerve block and insert a continuous nerve infusion catheter to my patient’s shoulder. This would allow me to administer “lidocaine-like” local anesthetic medications that numb the area and can safely be used in patients with sleep apnea without affecting their breathing.

Although I couldn’t cure my patient’s sleep apnea, I could assess and manage it tremendously, reducing his risk. He had an uneventful and successful surgery. I monitored and controlled his pain with the nerve catheter for the 48 hours after the operation, and now his shoulder is back in shape.