Update in regional anesthesia for shoulder surgery.

Overview

Recent advances in the application of regional anesthesia to the care of patients undergoing shoulder surgery are discussed. New techniques for the management of postoperative pain are highlighted, with an emphasis on interscalene patient-controlled analgesia and suprascapular block. New developments in the safety and effectiveness of brachial plexus block are presented. The technique of interscalene block used at our institution is discussed in detail. Intraoperative hypotension and bradycardia caused by activation of the Bezold-Jarisch reflex is considered. The ongoing debate regarding the use of paresthesia versus nerve-stimulator techniques is examined.