Efficacy of Combined Suprascapular Block and Axillary Nerve Block for Post-Operative Pain Management in Shoulder Arthroplasty: A Narrative Review.

PURPOSE OF REVIEW: Shoulder arthroplasty is associated with significant postoperative pain. Pain management following shoulder arthroplasty has been traditionally treated using interscalene block (ISB) and systemic opioids. However, these techniques are limited by short analgesic duration, respiratory complications, and a high risk of opioid dependence. Surgeons have considered the benefits of a multimodal approach via the suprascapular nerve block (SSNB) combined with an axillary nerve block (ANB) for managing postoperative pain following shoulder arthroplasty.The present investigation aims to evaluate the efficacy, safety, and clinical utility of a combined suprascapular nerve block (SSNB) and axillary nerve block (ANB) as an alternative to ISB for postoperative analgesia in shoulder arthroplasty. A comprehensive literature search was conducted and particular attention was given to outcomes such as pain control, opioid consumption, adverse events, and patient-specific considerations.

RECENT FINDINGS: Multiple studies demonstrate that SSNB + ANB provides comparable pain control to ISB while significantly reducing the risk of phrenic nerve paralysis, rebound hyperalgesia, and opioid-related complications. SSNB alone offers diaphragmatic-sparing benefits but may have limited analgesic coverage. When paired with ANB, the dual-block technique achieves broader sensory blockade and improved patient satisfaction. Recent advances in ultrasound-guided delivery and long-acting adjuvants, such as liposomal bupivacaine, dexmedetomidine, and dexamethasone, further enhance block duration and safety. The combined SSNB and ANB represents a safe, effective, patient-centered alternative to ISB for postoperative analgesia in shoulder arthroplasty. Its favorable safety profile and comparable efficacy make it especially valuable in high-risk populations and in settings aiming to reduce opioid reliance.