Regional anesthesia alone is associated with reduced intraoperative hypotension compared with combined general and regional anesthesia in shoulder arthroscopy performed in the beach-chair position

BACKGROUND: Shoulder arthroscopy in the beach-chair position is frequently associated with intraoperative hypotension, especially under general anesthesia (GA). Regional anesthesia (RA) alone may offer improved hemodynamic stability and facilitate ambulatory management. This study compared intraoperative hemodynamic effects of RA alone versus combined GA and RA. METHODS: We conducted a monocentric, retrospective cohort study including all adult patients undergoing elective shoulder arthroscopy between October 1, 2023, and October 1, 2024, at a private surgical center in Paris, France. Patients received either RA alone (interscalene+superficial cervical plexus block) or combined GA+RA. The primary outcome was any intraoperative occurrence of mean arterial pressure (MAP) <65 mm Hg. Multiple logistic regression models were constructed with stepwise adjustment for demographic variables and comorbidities. Secondary outcomes included hypotension duration, vasopressor use, intraoperative fluid administration, and postanesthesia care metrics. RESULTS: Among 482 patients, 417 (87%) received RA alone, and 65 (13%) received GA+RA. Hypotension occurred in 57% of patients with GA versus 13% with RA (p<0.001). GA was associated with hypotension (unadjusted OR 8.88 (95% CI 5.03 to 15.68); adjusted OR 10.25 (95% CI 5.51 to 19.08), p<0.001). This was confirmed in sensitivity analyses. GA patients had greater MAP reduction, longer hypotension duration, and higher vasopressor use. RA alone was associated with shorter operative time, reduced postanesthesia care unit stay (22 min vs 52 min), and more frequent same-day discharge (96% vs 75%, p<0.001). CONCLUSIONS: In elective shoulder arthroscopy, RA alone was associated with significantly greater hemodynamic stability, shorter recovery, and improved ambulatory outcomes compared with combined GA and RA.