Postoperative Pain Management after Shoulder Surgery: Current Regional Anesthesia Techniques and Multimodal Analgesia

Abstract

Postoperative pain following shoulder surgery can be moderate to severe, particularly during the first 24–48 hours, and may delay rehabilitation, restrict shoulder movement, and increase the risk of joint stiffness and chronic postoperative pain. Pain originates from the rich sensory innervation of the anterior and posterior glenohumeral capsule through branches of the axillary, subscapular, lateral pectoral, and suprascapular nerves. Therefore, effective perioperative analgesia is essential to improve patient comfort, facilitate early physiotherapy, and enhance functional recovery. Current management is based on a multimodal approach that combines systemic opioids, non-opioid analgesics, local anesthetic infiltration, and regional anesthesia techniques. Although opioids remain useful for moderate-to-severe pain, their adverse effects encourage opioid-sparing strategies. Interscalene brachial plexus block is considered the standard regional technique because of its excellent analgesic efficacy; however, its use may be limited by phrenic nerve palsy and hemidiaphragmatic paralysis. Consequently, several diaphragm-sparing alternatives have been developed, including superior trunk, infraclavicular–subomohyoid, subomohyoid–subscapularis, suprascapular, and axillary nerve blocks. Newer fascial plane techniques, such as the pericapsular nerve group and shoulder anterior capsule blocks, selectively target terminal articular branches supplying the shoulder capsule. These techniques may provide effective analgesia while preserving motor function and reducing respiratory complications associated with interscalene block.