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. 1. Introduction Common shoulder procedures include hemiarthroplasty, total shoulder arthroplasty, shoulder arthroscopy, subacromial decompression, and shoulder instability procedures such as rotator cuff repair. Anesthesia and analgesia for these surgical procedures are provided by general anesthesia, regional anesthesia, or the combination of general and regional anesthesia. Postoperative pain following shoulder surgery in many patients is severe and may be exacerbated by movement during rehabilitation [1]. Procedures done to help manage the dynamic pain of shoulder surgery include interscalene block, cervical paravertebral block, suprascapular nerve block, subacromial block, and intra-articular injections. Some of these techniques are performed as a single injection, while others are done as a single-injection or continuous infusion. There has been an increase in the number of surgical procedures done in the ambulatory environment. Single-injection and infusion systems utilizing portable, disposable elastomeric pumps help provide safe pain control in this environment. This paper will review the current literature regarding shoulder anesthesia and
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