Surgical Treatment of Permanent Diaphragm Paralysis After Interscalene Nerve Block for Shoulder Surgery

Abstract Background The interscalene nerve block provides analgesia for shoulder surgery, but is associated with diaphragm paralysis. One solution may be performing brachial plexus blocks more distally. This noninferiority study evaluated analgesia for blocks at the supraclavicular and anterior suprascapular levels, comparing them individually to the interscalene approach. Methods One hundred-eighty-nine subjects undergoing arthroscopic shoulder surgery were recruited to this double-blind trial and randomized to interscalene, supraclavicular, or anterior suprascapular block using 15 ml, 0.5% ropivacaine. The primary outcome was numeric rating scale pain scores analyzed using noninferiority testing. The predefined noninferiority margin was one point on the 11-point pain scale. Secondary outcomes included opioid consumption and pulmonary assessments. Results All subjects completed the study through the primary outcome analysis. Mean pain after surgery was: interscalene = 1.9 (95% CI, 1.3 to 2.5), supraclavicular = 2.3 (1.7 to 2.9), suprascapular = 2.0 (1.4 to 2.6). The primary outcome, mean pain score difference of supraclavicular–interscalene was 0.4 (–0.4 to 1.2; P = 0.088 for noninferiority) and of suprascapular–interscalene was 0.1 (–0.7 to 0.9; P = 0.012 for noninferiority). Secondary outcomes showed similar opioid consumption with better preservation of vital capacity in the anterior suprascapular group (90% baseline [P < 0.001]) and the supraclavicular group (76% [P = 0.002]) when compared to the interscalene group (67%). Conclusions The anterior suprascapular block, but not the supraclavicular, provides noninferior analgesia compared to the interscalene approach for major arthroscopic shoulder surgery. Pulmonary function is best preserved with the anterior suprascapular nerve block.

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The hemodynamic and postoperative pain control effect of interscalene nerve block and general anesthesia for arthroscopic shoulder surgery

European Journal of Anaesthesiology ◽

10.1097/00003643-201006121-00715 ◽

2010 ◽

Vol 27 ◽

pp. 222

Author(s):

K. Y. So ◽

S. H. Kim

Keyword(s):

Postoperative Pain ◽

General Anesthesia ◽

Nerve Block ◽

Pain Control ◽

Shoulder Surgery ◽

Control Effect ◽

Postoperative Pain Control ◽

Arthroscopic Shoulder Surgery ◽

Interscalene Nerve Block

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Effects of Interscalene Nerve Block for Postoperative Pain Management in Patients after Shoulder Surgery

BioMed Research International ◽

10.1155/2015/902745 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Hsiu-Pin Chen ◽

Shih-Jyun Shen ◽

Hsin-I Tsai ◽

Sheng-Chin Kao ◽

Huang-Ping Yu

Keyword(s):

Postoperative Pain ◽

Nerve Block ◽

Postoperative Pain Management ◽

Statistical Correlation ◽

Shoulder Surgery ◽

Adverse Outcomes ◽

Regional Nerve Block ◽

Severe Postoperative Pain ◽

Postoperative Shoulder ◽

Interscalene Nerve Block

Objectives. Shoulder surgery can produce severe postoperative pain and movement limitations. Evidence has shown that regional nerve block is an effective management for postoperative shoulder pain. The purpose of this study was to investigate the postoperative analgesic effect of intravenous patient-controlled analgesia (PCA) combined with interscalene nerve block in comparison to PCA alone after shoulder surgery.Methods. In this study, 103 patients receiving PCA combined with interscalene nerve block (PCAIB) and 48 patients receiving PCA alone after shoulder surgery were included. Patients’ characteristics, preoperative shoulder score and range of motion, surgical and anesthetic condition in addition to visual analog scale (VAS) pain score, postoperative PCA consumption, and adverse outcomes were evaluated.Results. The results showed that PCA combined with interscalene nerve block (PCAIB) group required less volume of analgesics than PCA alone group in 24 hours (57.76±23.29 mL versus87.29±33.73 mL,p<0.001) and 48 hours (114.86±40.97 mL versus183.63±44.83 mL,p<0.001) postoperatively. The incidence of dizziness in PCAIB group was significantly lower than PCA group (resp., 1.9% and 14.6%,p=0.005). VAS, nausea, and vomiting were less in group PCAIB, but in the absence of significant statistical correlation.Conclusion. Interscalene nerve block is effective postoperatively in reducing the demand for PCA analgesics and decreasing opioids-induced adverse events following shoulder surgery.

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