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Anesthetic options for shoulder surgery include general anesthesia, regional anesthesia, and a combination of the two. General anesthesia usually incorporates the use of an endotracheal tube, although a laryngeal mask airway, and, rarely, mask general anesthesia (for manipulation under anesthesia) may be acceptable. Regional anesthesia, particularly the use of an interscalene brachial plexus block, is becoming more popular. The successful use of cervical epidural anesthesia has also been reported, but this technique is not commonly used. A combination of general and regional anesthesia is frequently chosen so that postoperative analgesia can be optimized with the regional anesthetic. The anesthesiologist must treat patients of varying ages and levels of medical fitness among the patients presenting for shoulder surgery. Shoulder surgery is indicated for conditions including sports injuries, trauma, and age-related arthritic conditions. The individual patient's needs and preferences, the anesthesiologist's experience, and input from the surgeon will determine the anesthetic technique in any given situation. This article discusses anesthetic options, describes the performance and care of a patient under interscalene brachial plexus block anesthesia, and discusses the control of postoperative pain.