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Background and Aims Patients undergoing major total shoulder arthroplasty often receive interscalene block (ISBPB) for pain management. However, it carries a risk of phrenic nerve blockade, which can lead to significant pulmonary complications, particularly in the elderly. Neuromodulation is used in chronic pain as a modality to improve prolonged analgesia. This study investigates a novel technique: low-volume superior trunk block combined with percutaneous neuromodulation (STB-PTNS). Our primary aim was to assess if this approach could prolong the analgesic effect of the block, thereby reducing opioid consumption and its associated side effects in an elderly population.Methods This retrospective case series analysis was conducted as a quality improvement project after local committee approval. A total of 60 patients were included: 30 received the novel STB-PTNS (4–5 ml) and 30 received the standard ISBPB (10–40 ml) without neuromodulation. The analgesic efficacy was evaluated by patient-reported pain scores using the Numerical Rating Scale (NRS) and recorded opioid consumption. Data were collected immediately in recovery area and at 24 hours postoperatively prior to discharge.Results The average pain score in recovery was 4/10 for the STB-PTNS group and 6/10 for the ISBPB group. At 24 hours postoperatively, scores were 4/10 for STB-PTNS and 5/10 for ISBPB. A notable difference in opioid choice was observed; the STB-PTNS group predominantly utilised codeine and PRN oral morphine, while the ISBPB group required more oxycodone.Conclusions Percutaneous neuromodulation holds promise in acute pain settings due to its analgesic properties and ability to prolong block effects. Our findings suggest that low-volume superior trunk block with temporary percutaneous neuromodulation provides possible superior pain relief compared to interscalene block 24 hours postoperatively with reduced risks of phrenic nerve involvement. The effect of heterogeneity of patients and clinicians performing the block was evident. Further prospective research is warranted to evaluate long-term analgesia efficacy and opioid use.