When conservative treatment, including rest, oral analgesics and physiotherapy, fail to manage shoulder pain, surgical treatment should be considered. While interscalene block remains the gold standard for regional anaesthesia for shoulder surgery, there is a high incidence of hemi-diaphragmatic paralysis as a result of phrenic nerve block. As patients with pre-existing cardiopulmonary pathology are those who benefit most from regional anaesthesia, we explore the options for regional anaesthesia which spare the phrenic nerve.