Ultrasound-guided blocks for shoulder surgery.

PURPOSE OF REVIEW

There have been several recent insights in our understanding of how best to provide optimal perioperative anesthesia and analgesia for ambulatory shoulder surgery. This review attempts to distill the advances reported in the past 12-18 months and put them in perspective.

RECENT FINDINGS

Recent studies have explored the optimal dosing regimens and techniques for single-shot and continuous nerve blocks with regard to block effectiveness and complications. Further rigorously conducted studies into postoperative neurological and respiratory complications are correlated with study findings of brachial plexus anatomy. Evidence is presented supporting supraclavicular brachial plexus block as an equivalent alternative to interscalene block for ambulatory shoulder surgery.

SUMMARY

Following recent findings it is likely that the use of supraclavicular block will become more popular for shoulder surgery. However, further large-scale trials will be needed to definitively prove its advantages over the traditional interscalene block. On the contrary, the precision of ultrasound guidance and the ongoing optimization of postoperative continuous anesthetic infusion regimens continue to improve the performance characteristics of interscalene block.