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Background and Aims The interscalene brachial plexus block (ISB) is an alternative anesthesia technique frequently used in shoulder surgery. However, short-term hypertension (HT) has been reported following ISB. One of the critical determinants of success in arthroscopic shoulder surgery is the quality of intraoperative visualization. Hypertension may contribute to increased bleeding, potentially impairing visual clarity during the procedure. This study aims to compare the effects of ISB and general anesthesia (GA) on arthroscopic visualization in patients undergoing rotator cuff repair.Methods Following approval from the local ethics committee and informed consent from all patients, this prospective, randomized study included 80 patients aged ≥18 years who were assigned to either a GA group or an ISB group. The primary outcome was intraoperative visual clarity, which was assessed postoperatively by the operating surgeon using a 10-point arthroscopic visualization scale (grade 1 = worst visualization, grade 10 = best visualization; conversion to open surgery was considered at the lowest end of the scale).Results There were no statistically significant differences between the two groups in terms of age, comorbidities, gender, or duration of surgery (p > 0.05). However, visual clarity scores were significantly higher in the general anesthesia group compared to the ISB group (6.15 ± 2.02 vs. 4.73 ± 1.5, respectively; p < 0.001).Conclusions Although interscalene brachial plexus block (ISB) is a viable anesthesia technique for shoulder arthroscopy, lightly sedated patients under ISB may experience greater hemodynamic variability, potentially compromising arthroscopic visualization. In comparison, general anesthesia appears to provide superior visual clarity during rotator cuff repair.