Postoperative analgesia for shoulder surgery.

Both arthroscopic and open surgery of the shoulder are associated with significant postoperative pain. Use of opioids can result in adverse systemic effects, so a multi-modal analgesic approach and complementary analgesic techniques should be considered to minimize the postoperative opioid requirement. Single shot interscalene block provides effective pain control of early and limited duration which can be extended with a catheter. Continuous interscalene block should be considered for more invasive shoulder procedures. However, interscalene block is associated with hemidiaphragmatic paresis which is a substantial risk in patients with serious pulmonary pathology who could otherwise benefit most from a regional technique and the avoidance of opioids. Local infiltration analgesia, and suprascapular nerve block with or without axillary nerve block, have not been consistently shown to be superior to or as effective as interscalene block and there is insufficient evidence to support the use of supraclavicular block over interscalene block.