Shoulder surgery is associated with significant postoperative pain. A multimodal analgesia technique consisting of a combination of opioids, non-steroidal anti-inflammatory drugs, adjuvants and regional blocks can be given in the perioperative period. Use of opioid analgesia is often associated with significant side effects. The nerves supplying the shoulder region arise from the cervical and brachial plexuses. Ultrasound guided interscalene brachial plexus block is the main regional anesthetic technique used to provide pain relief. It can be given either as a single shot, or a catheter can be inserted for continuous analgesia. It is associated with hemidiaphragmatic paresis, which may be particularly challenging for patients with severe pulmonary disease. Local infiltration, suprascapular nerve block with or without axillary nerve block, superior trunk block and supraclavicular brachial plexus block are alternative techniques that can be used. We have discussed key issues related to perioperative analgesia of a patient undergoing shoulder surgery.