Shoulder Arthroscopy

Abstract Most shoulder innervation arises from nerves C5 to T1, with occasional contributions from C4 or T2. A patient’s pulmonary status and ability to tolerate a change in diaphragmatic function should be assessed prior to an interscalene block. Regional anesthetic options for a patient with compromised pulmonary function include a more distal brachial plexus block, superior trunk block, and suprascapular block. Expectations regarding the regional anesthetic technique should be set with the patient. The role of the block in the context of the overall pain-control plan and other analgesic agents should be explained. Rebound pain is significant when it alters a patient’s recovery trajectory. A single-injection interscalene block may not be sufficient to properly address pain after shoulder surgery. Anesthesiologists should properly educate patients about peripheral nerve blockade, including expected pain control, possible side effects, and ambulatory nerve catheter care, if applicable.