Current Strategies in Regional Anesthesia for Shoulder Surgery

As arthroscopic and open shoulder surgery is increasingly performed on an outpatient basis, optimal and prolonged pain control is becoming more important while minimizing associated adverse effects. Traditional analgesic strategies relying on opioid and nonopioid medications provide inadequate pain control and are associated with undesirable adverse effects, such as opioid-related adverse effects (postoperative nausea and vomiting, respiratory depression, sedation), gastric lining irritation, and renal and hepatic adverse effects. Advances in ultrasonography-guided regional anesthesia have made placement of interscalene brachial plexus nerve blocks more reliable and precise and aided development of novel phrenic nerve-sparing peripheral nerve block techniques that decrease the risk of diaphragmatic paresis and dyspnea. Using a brachial plexus block combined with multimodal medications is the preferred method to provide comprehensive analgesia to target multiple pain pathways for additive or synergistic pain control effects in the perioperative period while minimizing opioid medication usage. An understanding of current anesthetic and analgesic strategies can lead to an improved pain management pathway and outcomes in patients undergoing shoulder surgery.