Regional analgesia for shoulder surgery

Abstract

The skin over the neck and proximal shoulder is supplied by the superficial cervical plexus including the supraclavicular nerve (C3-C4) which innervates the skin above and below the clavicle. While the suprascapular nerve innervates the posterior shoulder, primary innervation of the shoulder occurs via the axillary nerve (Figs. 1 and 2). Both the axillary and suprascapular nerves consist of fibers from the most cephalad contributions to the brachial plexus (C5 and C6) (Fig. 3). Effective approaches to analgesia for shoulder surgery target the brachial plexus at the level of the upper roots/proximal trunks (interscalene block) and distal trunks/divisions (supraclavicular block) (Fig. 4).