Local anaesthesia may be used for shoulder arthroscopy and Warren et al have reported a series of 44 arthroscopic subacromial decompressions performed under scalene block without anaesthetic problems. However, general anaesthesia for shoulder arthroscopy is preferable. General anaesthesia prevents embarrassment to the surgeon and loss of faith by the patient during the learning curve of the procedure, when the surgeon's dexterity may not match the patient's expectations! It is essential that the patient is intubated in order to remove both the anaesthetist and the anaesthetic equipment from the operative field, and to allow the surgeon to reach across the patient's head. The patient should be adequately monitored and all pressure areas should be properly padded.
When the lateral decubitus position is used, an axillary roll should be placed under the patient in order to prevent undue strain being placed on the brachial plexus of the unoper-ated side (Figure 4.10).
Figure 4.10 An axillary roll is placed under the patient to protect the brachial plexus of the unoperated side.