{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T15:09:49Z","timestamp":1793372989619,"version":"4.5.0"},"reference-count":27,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2025,6,1]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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) &lt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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&lt;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&lt;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\u2009min), and more frequent same-day discharge (96% vs 75%, p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2025-106738","type":"journal-article","created":{"date-parts":[[2025,6,8]],"date-time":"2025-06-08T16:25:14Z","timestamp":1749399914000},"page":"947-953","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["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"],"prefix":"10.1136","volume":"51","clinical-trial-number":[{"clinical-trial-number":"nct06451380","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Vladimir","family":"Cohen-Balaloum","sequence":"first","affiliation":[{"name":"Ramsay Health, Jouvenet Clinic, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gr\u00e9goire","family":"Ciais","sequence":"additional","affiliation":[{"name":"Ramsay Health, Jouvenet Clinic, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Raingeval","sequence":"additional","affiliation":[{"name":"Ramsay Health, Jouvenet Clinic, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9504-4011","authenticated-orcid":false,"given":"Philippe","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Ramsay Health, Jouvenet Clinic, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,8]]},"reference":[{"key":"2026080502150686000_51.8.947.1","doi-asserted-by":"publisher","DOI":"10.1097\/01.anes.0000270724.40897.8e"},{"key":"2026080502150686000_51.8.947.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12871-022-01605-9","article-title":"Reported definitions of intraoperative hypotension in adults undergoing non-cardiac surgery under general anaesthesia: a review","volume":"22","author":"Weinberg","year":"2022","journal-title":"BMC Anesthesiol"},{"key":"2026080502150686000_51.8.947.3","doi-asserted-by":"publisher","DOI":"10.1007\/s40262-018-0672-3"},{"key":"2026080502150686000_51.8.947.4","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1213\/ANE.0000000000004654","article-title":"The Influence of Hemorrhagic Shock on the Disposition and Effects of Intravenous Anesthetics: A Narrative Review","volume":"130","author":"Egan","year":"2020","journal-title":"Anesth Analg"},{"key":"2026080502150686000_51.8.947.5","first-page":"286","article-title":"Sufentanil. A review of its pharmacological properties and therapeutic use","volume":"36","author":"Monk","year":"1988","journal-title":"Drugs (Abingdon Engl)"},{"key":"2026080502150686000_51.8.947.6","doi-asserted-by":"publisher","DOI":"10.1093\/bjaceaccp\/mkt038"},{"key":"2026080502150686000_51.8.947.7","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001432"},{"key":"2026080502150686000_51.8.947.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.04.036"},{"key":"2026080502150686000_51.8.947.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.14172"},{"key":"2026080502150686000_51.8.947.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-8063(05)80425-6"},{"key":"2026080502150686000_51.8.947.11","doi-asserted-by":"crossref","first-page":"344","DOI":"10.4103\/aer.AER_231_17","article-title":"Inter Scalene Block: Revisiting old technique","volume":"12","author":"Vaid","year":"2018","journal-title":"Anesth Essays Res"},{"key":"2026080502150686000_51.8.947.12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2009.06231.x"},{"key":"2026080502150686000_51.8.947.13","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.jor.2017.07.002","article-title":"Comparison of general versus isolated regional anesthesia in total shoulder arthroplasty: A retrospective propensity-matched cohort analysis","volume":"14","author":"Ding","year":"2017","journal-title":"J Orthop"},{"key":"2026080502150686000_51.8.947.14","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200111000-00025"},{"key":"2026080502150686000_51.8.947.15","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200407000-00020"},{"key":"2026080502150686000_51.8.947.16","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000150944.95158.B9"},{"key":"2026080502150686000_51.8.947.17","doi-asserted-by":"crossref","first-page":"s865","DOI":"10.3928\/0147-7447-20030802-08","article-title":"Anesthesia and postoperative analgesia: outcomes following orthopedic surgery","volume":"26","author":"Chelly","year":"2003","journal-title":"Orthopedics"},{"key":"2026080502150686000_51.8.947.18","doi-asserted-by":"publisher","DOI":"10.1007\/BF02713914"},{"key":"2026080502150686000_51.8.947.19","doi-asserted-by":"crossref","first-page":"2640","DOI":"10.1016\/j.arthro.2024.07.031","article-title":"Regional Anesthesia Should Be the Standard for All Arthroscopic Shoulder Surgeries","volume":"40","author":"Nguyen","year":"2024","journal-title":"Arthroscopy"},{"key":"2026080502150686000_51.8.947.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2004.09.012"},{"key":"2026080502150686000_51.8.947.21","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.jor.2019.05.009","article-title":"Shoulder surgery in beach chair position causing perioperative stroke: Four cases and a review of the literature","volume":"16","author":"van Erp","year":"2019","journal-title":"J Orthop"},{"key":"2026080502150686000_51.8.947.22","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.redar.2013.08.002","article-title":"Cerebral oxygenation in patients undergoing shoulder surgery in beach chair position: comparing general to regional anesthesia and the impact on neurobehavioral outcome","volume":"61","author":"Aguirre","year":"2014","journal-title":"Rev Esp Anestesiol Reanim"},{"key":"2026080502150686000_51.8.947.23","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e31828446bb"},{"key":"2026080502150686000_51.8.947.24","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2253-14-50","article-title":"Blood pressure response to combined general anaesthesia\/interscalene brachial plexus block for outpatient shoulder arthroscopy","volume":"14","author":"Janssen","year":"2014","journal-title":"BMC Anesthesiol"},{"key":"2026080502150686000_51.8.947.25","doi-asserted-by":"crossref","DOI":"10.3928\/01477447-20090401-23","article-title":"Prevalence of cerebrovascular events during shoulder surgery and association with patient position","volume":"32","author":"Friedman","year":"2009","journal-title":"Orthopedics"},{"key":"2026080502150686000_51.8.947.26","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.01550"},{"key":"2026080502150686000_51.8.947.27","doi-asserted-by":"publisher","DOI":"10.1080\/17453674.2019.1683790"}],"container-title":["Regional Anesthesia &amp; 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