Regional anesthesia for shoulder surgery: A narrative review on current techniques and clinical considerations
Hüseyin Erdoğan1
, Rafet Onur Görgülü1, Ata Cem Akbaba2, Teoman Toprak3, İrem Özdemir4, Yavuz Gürkan1
1Department of Anaesthesiology and Reanimation, Koç University Faculty of Medicine Hospital, İstanbul, Türkiye
2Department of Orthopaedics and Traumatology, Koç University Faculty of Medicine Hospital, İstanbul, Türkiye
3Department of Biology, University of Washington, Seattle, WA, USA
4Department of Algology, Koç University Faculty of Medicine Hospital, İstanbul, Türkiye
Keywords: Brachial plexus, regional anesthesia, phrenic nerve, postoperative pain, shoulder.
Abstract
An aging population and longer lifespans have markedly increased the number of shoulder surgeries. Technological advances have made arthroscopic techniques increasingly prominent owing to their minimally invasive nature and lower risk to surrounding structures. Effective postoperative pain management is, therefore, essential and has prompted continued advances in nerve block techniques. Although the interscalene brachial plexus block (ISBPB) is widely regarded as the standard technique for shoulder surgery, phrenic nerve involvement may result in hemidiaphragmatic paresis. The clinical significance of this effect depends largely on the patient's respiratory reserve. The search therefore continues for techniques that optimize postoperative analgesia while preserving respiratory function. In this review, we aim to provide an evidence-based overview to assist anesthesiologists in selecting patient- and procedure-specific regional anesthesia techniques that achieve an appropriate balance between analgesic efficacy and safety.
Cite this article as: Erdoğan H, Görgülü RO, Akbaba AC, Toprak T, Özdemir İ, Gürkan Y. Regional anesthesia for shoulder surgery: A narrative review on current techniques and clinical considerations. Agri 2026;38(4):215-225. doi: 10.5606/agri.2026.196.
H.E.: This author was responsible for methodology, writing review and editing preparation; R.O.G.: This author was responsible for the data curation, writing-original draft preparation, visualizations and editing sections of the article; A.C.A.: This author was responsible for preparing the first draft of the manuscript and contributed to the preparation of visualizations; T.T.: This author was responsible for conducting the literature review and for proofreading the English text; İ.Ö.: This author was responsible for reviewing the literature and for drafting and editing the final version of the manuscript; Y.G.: This author contributed to the methodology, resources, writing-original draft preparation, visualizations and supervision sections of this paper.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.
The authors received no financial support for the research and/or authorship of this article.
Data Sharing Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.