Application of Dexmedetomidine Sedation Combined With Suprascapular Nerve Block and Axillary Nerve Block in Shoulder Arthroscopy, A Randomized Single-Blind Study

Objective: The aim of the present study was to evaluate the anesthetic and analgesic effects of dexmedetomidine combined with suprascapular nerve block and axillary nerve block in shoulder arthroscopy.Methods: A total of 60 patients were randomly divided into the experimental group (DEX group) and the control group (GA group) via a random number table method. Dexmedetomidine sedation combined with suprascapular nerve block and axillary nerve block was used in the DEX group, while general anesthesia with tracheal intubation combined with interscalene brachial plexus block was used in the GA group. The perioperative indexes, intraoperative hemodynamics, cerebral oxygen saturation, and postoperative pain score, as well as any complications, were compared between the two groups.Results: The anesthesia duration (p < 0.05) and postoperative monitoring time (p < 0.05) in the DEX group were significantly shorter than those in the GA group. At most time points during the anesthesia, the cerebral oxygen saturation (p < 0.05) and mean arterial pressure (p < 0.05) in the DEX group were significantly higher than those in the GA group. Additionally, the decrease in the cerebral oxygen saturation and mean arterial pressure in the GA group was significantly higher than that in the DEX group (p < 0.05). The pain score of DEX group 12 h after operation significantly lower than that in the GA group (p < 0.05), and the incidence of postoperative hypoxemia along with nausea and vomiting in the GA group was significantly higher than that in the DEX group (p < 0.05).Conclusion: Dexmedetomidine combined with suprascapular nerve block and axillary nerve block could reduce the incidence of hypoxemia, while the approach demonstrated better hemodynamic stability, fully ensured the cerebral blood perfusion, and exhibited better anesthetic and analgesic effects, meaning it could be safely and effectively applied in shoulder arthroscopy procedures.

Comparison of Ultrasound-Guided Supra-scapular Plus Axillary Nerve Block with Interscalene Block for Postoperative Pain Management in Arthroscopic Shoulder Surgery; A Double-Blinded Randomized Open-Label Clinical Trial

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.

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

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.