Shoulder arthroscopy poses significant challenges in anesthetic management and pain control. The beach chair position, favored for its surgical advantages, such as improved airway access, better visualization, and enhanced shoulder stabilization, also carries anesthetic and neurological risks, including cervical neuropraxia, bradycardia, hypotension, and cerebral ischemia. These complications are particularly common in patients receiving interscalene blocks or general anesthesia. Effective management requires precise head positioning, vigilant hemodynamic monitoring, and appropriate anesthesia techniques. Postoperative pain can be severe and prolonged, requiring effective management strategies. The shift away from opioid-based analgesia, due to adverse effects, has led to the adoption of multimodal analgesia, combining regional anesthesia, non-opioid medications, and complementary therapies. This approach improves recovery, reduces side effects, and is cost-effective, especially in outpatient settings. Additionally, controlled hypotension, while beneficial for improving surgical visualization, demands careful monitoring of blood pressure and cerebral perfusion, particularly in the beach chair position. Invasive blood pressure monitoring and fluid balance are essential to prevent cerebral hypoperfusion in vulnerable patients. The interscalene brachial plexus block is useful for shoulder and upper limb surgeries. Advances in ultrasound guidance have enhanced the precision and safety of both single-injection and continuous blocks, reducing local anesthetic volume and complications such as phrenic nerve paralysis, while improving block quality and success rates.