Shoulder Surgery Under Regional Anesthesia With Sedation Without General Anesthesia: A Case Series

INTRODUCTION: In Brazil, shoulder surgeries are traditionally performed under general anesthesia combined with regional blocks. This study aimed to describe the feasibility and safety profile of regional anesthesia with sedation, without general anesthesia, for shoulder surgery. MATERIALS AND METHODS: Following approval by the institutional ethics committee, 10 consecutive patients undergoing elective shoulder surgery (arthroscopy, n = 6; arthroplasty, n = 4) received an ultrasound-guided superior trunk block of the brachial plexus combined with an intermediate superficial cervical plexus block using ropivacaine. The primary outcome was the conversion rate to general anesthesia. Secondary outcomes included intraoperative hemodynamic stability, pain scores, post-anesthesia recovery time, length of hospital stay, patient satisfaction (net promoter score, NPS), and complications within 14 days. RESULTS: All blocks were successfully performed (100%). No patient required conversion to general anesthesia (0%). Intraoperative hypotension occurred in 30% of cases and was more frequent in arthroplasty procedures (50%) than in arthroscopy procedures (16.7%). The mean post-anesthesia care unit stay was 51 ± 10 minutes. Seventy percent of patients were discharged on the same day (83.3% of arthroscopy patients and 50% of arthroplasty patients). Only one patient (10%) required rescue opioid (tramadol) within the first 24 hours. Two patients experienced transient hoarseness, which resolved completely within nine hours. No cases of Horner syndrome, persistent neurological symptoms at 24 hours, 7 days, or 14 days, readmissions, or reoperations within 30 days were observed. The NPS was 10 in all patients. CONCLUSIONS: Regional anesthesia alone using a superior trunk block combined with a superficial cervical plexus block is feasible and safe for shoulder surgery without the need for conversion to general anesthesia. These preliminary findings support the potential for practice change in Brazil; however, larger studies are needed to confirm these results.