The article reviews the current literature regarding shoulder
anesthesia and analgesia. Techniques and outcomes are presented that summarize our present understanding of
regional anesthesia for the shoulder. Shoulder procedures producing mild to moderate
pain may be managed with a single-injection interscalene block. However, studies support that moderate to severe
pain, lasting for several days is best managed with a continuous interscalene block. This may cause increased extremity
numbness, but will provide greater
analgesia, reduce supplemental
opioid consumption, improve sleep quality and patient satisfaction. In comparison to the nerve stimulation technique, ultrasound can reduce the volume of
local anesthetic needed to produce an effective interscalene block. However, it has not been shown that ultrasound offers a definitive benefit in preventing major complications. The evidence indicates that the suprascapular and/or axillary
nerve blocks are not as effective as an interscalene block. However in patients who are not candidates for the interscalene block, these blocks may provide a useful alternative for short-term
pain relief. There is substantial evidence showing that subacromial and
intra-articular injections provide little clinical benefit for postoperative
analgesia. Given that these
injections may be associated with irreversible chondrotoxicity, the
injections are not presently recommended.