Harley Jonathan D, Harrison Alicia K, Rao Allison J
Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
Ann Jt. 2025 Jun 30;10:29. doi: 10.21037/aoj-24-64. eCollection 2025.
Perioperative pain management is of considerable interest in shoulder surgery due to its association with severe postoperative pain. Over time, regional anesthesia has become widely utilized in postoperative pain control. Because poor pain management after orthopedic surgery remains an issue, optimal utilization of regional anesthesia should continue to be a focus for shoulder surgeons. This review seeks to summarize the most commonly used regional anesthesia techniques in shoulder surgery while highlighting key innovations in these areas. Furthermore, it will appraise the available high-quality evidence on these topics, providing a snapshot of the most current practices and conclusions.
PubMed was queried for studies published within the previous 20 years on topics of regional anesthesia procedures for shoulder surgery. The most recent high-quality studies-systematic reviews, meta-analyses, and randomized controlled trials-were prioritized for selection. Additional references were identified from the reference lists of these articles.
The interscalene brachial plexus block (ISB), the supraclavicular brachial plexus block (SCB), and the suprascapular nerve block (SSNB) are at the forefront of regional anesthesia for shoulder surgery. ISB remains the gold standard, offering the most complete anesthesia. SCB and SSNB have important roles as well, having a lower risk of complications but the additional requirement of general anesthesia (GA). Continuous catheter infusion (CCI), while effective in extending analgesia, has fallen out of favor due to its safety concerns, such as catheter migration. Adjuvant medications have become more popular in recent years and have been shown to prolong nerve blockade, with intravenous dexamethasone and dexmedetomidine gaining significant traction. Liposomal bupivacaine (LB), a newer advancement, increases nerve block duration but has shown mixed evidence in improving patient outcomes.
Regional anesthesia plays a major role in postoperative pain management and has changed the landscape of how patients can recover from shoulder surgery. ISB, SCB, and SSNB techniques all have their place, each offering unique advantages and disadvantages. CCI and adjuvant medications have shown benefit, while LB requires further investigation. Future research should aim to refine regional anesthesia techniques to further improve outcomes.
由于围手术期疼痛管理与严重的术后疼痛相关，因此在肩部手术中备受关注。随着时间的推移，区域麻醉已广泛应用于术后疼痛控制。由于骨科手术后疼痛管理不佳仍是一个问题，区域麻醉的最佳应用应继续成为肩部外科医生关注的焦点。本综述旨在总结肩部手术中最常用的区域麻醉技术，同时突出这些领域的关键创新。此外，它将评估这些主题的现有高质量证据，提供当前最新实践和结论的概述。
在PubMed上查询过去20年内发表的关于肩部手术区域麻醉程序主题的研究。优先选择最近的高质量研究——系统评价、荟萃分析和随机对照试验。从这些文章的参考文献列表中识别其他参考文献。
肌间沟臂丛神经阻滞（ISB）、锁骨上臂丛神经阻滞（SCB）和肩胛上神经阻滞（SSNB）是肩部手术区域麻醉的前沿技术。ISB仍然是金标准，提供最完全的麻醉。SCB和SSNB也有重要作用，并发症风险较低，但需要额外的全身麻醉（GA）。连续导管输注（CCI）虽然在延长镇痛方面有效，但由于其安全问题，如导管移位，已不再受欢迎。近年来，辅助药物越来越受欢迎，已被证明可延长神经阻滞时间，静脉注射地塞米松和右美托咪定获得了显著关注。脂质体布比卡因（LB）是一项较新的进展，可延长神经阻滞持续时间，但在改善患者预后方面的证据不一。
区域麻醉在术后疼痛管理中起着重要作用，并改变了患者从肩部手术中恢复的方式。ISB、SCB和SSNB技术都有其适用之处，各自具有独特的优缺点。CCI和辅助药物已显示出益处，而LB需要进一步研究。未来的研究应旨在改进区域麻醉技术，以进一步改善治疗效果。
