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Anesthesiology Research and Practice
Volume 2012 (2012), Article ID 971963, 12 pages
http://dx.doi.org/10.1155/2012/971963
Review Article

Regional Blockade of the Shoulder: Approaches and Outcomes

Department of Anesthesiology, Vanderbilt University School of Medicine, 1301 Medical Center Drive, 4648 The Vanderbilt Clinic, Nashville, TN 37232-5614, USA

Received 6 February 2012; Accepted 7 May 2012

Academic Editor: Attila Bondar

Copyright © 2012 Clifford Bowens and Ramprasad Sripada. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The article reviews the current literature regarding shoulder anesthesia and analgesia. Techniques and outcomes are presented that summarize our present understanding of regional anesthesia for the shoulder. Shoulder procedures producing mild to moderate pain may be managed with a single-injection interscalene block. However, studies support that moderate to severe pain, lasting for several days is best managed with a continuous interscalene block. This may cause increased extremity numbness, but will provide greater analgesia, reduce supplemental opioid consumption, improve sleep quality and patient satisfaction. In comparison to the nerve stimulation technique, ultrasound can reduce the volume of local anesthetic needed to produce an effective interscalene block. However, it has not been shown that ultrasound offers a definitive benefit in preventing major complications. The evidence indicates that the suprascapular and/or axillary nerve blocks are not as effective as an interscalene block. However in patients who are not candidates for the interscalene block, these blocks may provide a useful alternative for short-term pain relief. There is substantial evidence showing that subacromial and intra-articular injections provide little clinical benefit for postoperative analgesia. Given that these injections may be associated with irreversible chondrotoxicity, the injections are not presently recommended.