Anesthetic options for shoulder surgery include general anesthesia, regional anesthesia with or without sedation, and a combination of regional and general anesthesia. In the latter case, the addition of regional anesthesia will result in reduced general anesthetic requirements and postoperative analgesia of varying duration. The use of regional anesthesia, in the form of interscalene brachial plexus blockade, is gaining popularity because of the numerous benefits that have been attributed to this type of anesthesia. Because shoulder surgery frequently results in severe postoperative pain, the preemptive and intense intraoperative analgesia provided by interscalene blockade, as well as the use of a long-acting block or a continuous catheter technique for postoperative analgesia is of significant benefit to the patient. Whenever a regional anesthetic technique is used, a thorough knowledge of anatomy (with respect to nerve blockade as well as the surgical procedure), and meticulous care of the patient intraoperatively, are essential prerequisites for a successful outcome.