The shoulder block is a selective block of the nerves innervating the shoulder: suprascapular and axillary nerves. It is an alternative analgesic technique to the interscalene or supraclavicular brachial plexus blocks that avoid the motor block of the arm and hand and the phrenic nerve (hemidiaphragmatic paresis). In this issue of the newsletter, we feature a pictorial guide to Axillary Nerve Block, from the NYSORA’s Regional Anesthesia Module.

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Clinical Update

Nanda and Auyong (Current Opinion in Anesthesiology, 2026) report that phrenic-sparing strategies for shoulder surgery involve a trade-off between respiratory safety and block completeness: reducing interscalene block volume/concentration or using superior trunk and supraclavicular approaches lowers but does not eliminate hemidiaphragmatic paresis (HDP). Distal combinations, particularly suprascapular nerve block with anterior axillary or infraclavicular block, can reduce HDP to near zero while maintaining useful shoulder analgesia, making them particularly relevant for patients with limited respiratory reserve; ISB remains the most reliable option when complete analgesia or surgical anesthesia is the priority.

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