An update on regional anesthesia in shoulder surgery: a narrative review

Perioperative pain management is of considerable interest in shoulder surgery due to its association with severe postoperative pain. Over time, regional anesthesia has become widely utilized in postoperative pain control. Because poor pain management after orthopedic surgery remains an issue, optimal utilization of regional anesthesia should continue to be a focus for shoulder surgeons. This review seeks to summarize the most commonly used regional anesthesia techniques in shoulder surgery while highlighting key innovations in these areas. Furthermore, it will appraise the available high-quality evidence on these topics, providing a snapshot of the most current practices and conclusions.

PubMed was queried for studies published within the previous 20 years on topics of regional anesthesia procedures for shoulder surgery. The most recent high-quality studies-systematic reviews, meta-analyses, and randomized controlled trials-were prioritized for selection. Additional references were identified from the reference lists of these articles.

The interscalene brachial plexus block (ISB), the supraclavicular brachial plexus block (SCB), and the suprascapular nerve block (SSNB) are at the forefront of regional anesthesia for shoulder surgery. ISB remains the gold standard, offering the most complete anesthesia. SCB and SSNB have important roles as well, having a lower risk of complications but the additional requirement of general anesthesia (GA). Continuous catheter infusion (CCI), while effective in extending analgesia, has fallen out of favor due to its safety concerns, such as catheter migration. Adjuvant medications have become more popular in recent years and have been shown to prolong nerve blockade, with intravenous dexamethasone and dexmedetomidine gaining significant traction. Liposomal bupivacaine (LB), a newer advancement, increases nerve block duration but has shown mixed evidence in improving patient outcomes.

Regional anesthesia plays a major role in postoperative pain management and has changed the landscape of how patients can recover from shoulder surgery. ISB, SCB, and SSNB techniques all have their place, each offering unique advantages and disadvantages. CCI and adjuvant medications have shown benefit, while LB requires further investigation. Future research should aim to refine regional anesthesia techniques to further improve outcomes.