Regional anesthesia for shoulder surgery: A narrative review on current techniques and clinical considerations

An aging population and longer lifespans have markedly increased the number of shoulder surgeries. Technological advances have made arthroscopic techniques increasingly prominent owing to their minimally invasive nature and lower risk to surrounding structures. Effective postoperative pain management is, therefore, essential and has prompted continued advances in nerve block techniques. Although the interscalene brachial plexus block (ISBPB) is widely regarded as the standard technique for shoulder surgery, phrenic nerve involvement may result in hemidiaphragmatic paresis. The clinical significance of this effect depends largely on the patient's respiratory reserve. The search therefore continues for techniques that optimize postoperative analgesia while preserving respiratory function. In this review, we aim to provide an evidence-based overview to assist anesthesiologists in selecting patient- and procedure-specific regional anesthesia techniques that achieve an appropriate balance between analgesic efficacy and safety.