A Comparison of Combined Suprascapular and Axillary Nerve Blocks to Interscalene Nerve Block for Analgesia in Arthroscopic Shoulder Surgery

Background: Post-arthroscopic shoulder surgery pain is severe enough to interfere with initial recovery and rehabilitation. Objectives: We aimed to evaluate the analgesic effects of postoperative ultrasound-guided suprascapular plus axillary nerve blocks superficial subepidermal axon bundles (SSAB) with interscalene block (ISB) in arthroscopic shoulder surgery. Methods: In this single-blind randomized, open-label clinical trial, 80 candidates of elective arthroscopic shoulder surgery were randomly allocated to receive either SSAB or ISB at a postoperative care unit. The severity of resting and changing position pain was measured using visual analogue scale (VAS) score at 4h, 8h, 12h, 16h, and 24h, postoperatively. Timing of first opioid request, 24h dose requirement, patients' satisfaction rate, and side effects were also recorded. All registered data were analyzed using SPSS software version 23 for Windows (SPSS, Chicago, IL). Results: Resting and changing position pain scores were comparable between SSAB and ISB groups in the most time intervals. At 12h, moving and resting pain was significantly lower in ISB than SSAB group, while moving pain was more severe in ISB group at 24h assessment. Patient satisfaction scores were comparable between the two groups except for 12h assessment. Time to first analgesic requirement and total dose of 24h opioid requirement were not significantly different between the two groups. Conclusions: Suprascapular plus axillary nerve block could be an effective and safe alternative for interscalene block for pain management after arthroscopic shoulder surgery.

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EFFECT OF SUPRASCAPULAR AND AXILLARY NERVE BLOCK ON SEVOFLURANE CONSUMPTION AND POSTOPERATIVE PAIN RELIEF IN ARTHROSCOPIC SHOULDER SURGERY

10.26226/morressier.5b519f6bb1b87b000ecf16aa ◽

2018 ◽

Author(s):

Ozkan Derya ◽

Cemaloglu Sevtap

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Nerve Block ◽

Axillary Nerve ◽

Shoulder Surgery ◽

Postoperative Pain Relief ◽

Arthroscopic Shoulder Surgery ◽

Axillary Nerve Block

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A COMPARATIVE STUDY BETWEEN INTERSCALENE BLOCK AND SUPRASCAPULAR PLUS AXILLARY NERVE BLOCK IN PATIENTS UNDERGOING SHOULDER SURGERY

10.36106/ijsr/0217008 ◽

2021 ◽

pp. 72-74

Author(s):

Swati Dutta ◽

Sudakshina Mukherjii ◽

Manjushree Ray ◽

Gautam Lahiri ◽

Arup Chakraborty

Keyword(s):

Nerve Block ◽

Visual Analog Scale Score ◽

Axillary Nerve ◽

Shoulder Surgery ◽

Interscalene Block ◽

Block Group ◽

Nerve Blocks ◽

Number Of Patients ◽

Axillary Nerve Block

The interscalene block is the gold standard for shoulder anesthesia. The suprascapular nerve block combined with an axillary nerve block may provide an efcacious alternative to the interscalene nerve block for shoulder surgery. To compare interscalene block with suprascapular plus axillary nerve block for shoulder surgery in terms of quality of anaesthesia, duration of analgesia and, associated complications. Seventy one patients were randomly allocated in two groups to receive either interscalene block (Group IG, number of patients =35) or suprascapular plus axillary nerve block (Group SG, number of patients = 36). Onset of block, quality of block, failure rate and incidence of complications were observed. Postoperative pain was assessed by Visual Analog Scale. Score ≥4 was considered as signicant pain and, rescue analgesic injection tramadol 100 mg was administered. Onset of sensory block was 17.67±6.11 min and 15.29±1.72 min in group SG and IG respectively. Similarly duration of block was 247.61±78.46 min (Group SG) and 268.11±24.78 min (Group IG) (p=0.1332). Majority of patients had grade III motor block in group IG (74%) and grade II in group SG (89%). Three patients had either partial or complete failure of block in SG group. Interscalene block provided longer duration of postoperative analgesia. Both interscalene block and suprascapular plus axillary nerve block provide effective anaesthesia and analgesia for shoulder surgery. Although quality of block is better following interscalene block; suprascapular and axillary nerve blocks are associated with fewer side effects.

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Postoperative analgesia for arthroscopic shoulder surgery: comparison between ultrasound-guided interscalene block and combined suprascapular and axillary nerve blocks

Ain-Shams Journal of Anaesthesiology ◽

10.4103/1687-7934.198260 ◽

2016 ◽

Vol 9 (4) ◽

pp. 536 ◽

Cited By ~ 2

Author(s):

Abdalla Waleed

Keyword(s):

Postoperative Analgesia ◽

Axillary Nerve ◽

Shoulder Surgery ◽

Interscalene Block ◽

Ultrasound Guided ◽

Nerve Blocks ◽

Arthroscopic Shoulder Surgery

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Comparison of Anterior Suprascapular, Supraclavicular, and Interscalene Nerve Block Approaches for Major Outpatient Arthroscopic Shoulder Surgery

Anesthesiology ◽

10.1097/aln.0000000000002208 ◽

2018 ◽

Vol 129 (1) ◽

pp. 47-57 ◽

Cited By ~ 33

Author(s):

David B. Auyong ◽

Neil A. Hanson ◽

Raymond S. Joseph ◽

Brian E. Schmidt ◽

April E. Slee ◽

...

Keyword(s):

Nerve Block ◽

Primary Outcome ◽

Rating Scale ◽

Shoulder Surgery ◽

Opioid Consumption ◽

Outcome Analysis ◽

Double Blind ◽

Arthroscopic Shoulder Surgery ◽

Secondary Outcomes ◽

Interscalene Nerve Block

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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