A Randomized Comparison Between Interscalene and Small-Volume Supraclavicular Blocks for Arthroscopic Shoulder Surgery

Aliste, Julián; Fernández, Diego; Layera, Sebastián; Finlayson, Roderick J.; Tran, De Q.H.

doi:10.1097/aap.0000000000000767

Cited by 38 publications

(35 citation statements)

References 22 publications

(27 reference statements)

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“…The protocol employed in the current study was similar to the ones used in our two previous trials, which investigated combined infraclavicular–suprascapular blocks9 and small-volume supraclavicular blocks10 as diaphragm-sparing alternatives to ISB. After arrival in the induction room, an 18-gauge or 20-gauge intravenous catheter was placed in the upper limb contralateral to the surgical site and intravenous premedication (2 mg of midazolam and 50 µg of fentanyl) was administered to all patients.…”

Section: Methodsmentioning

confidence: 99%

“…In the ISB group, the US transducer was applied in a sterile fashion on the lateral side of the neck at the level of the cricoid cartilage in order to obtain a view of the three hypoechoic structures, which represent the roots/trunks of the brachial plexus 10. A skin weal was raised with 3 mL of lidocaine 1%.…”

Section: Methodsmentioning

confidence: 99%

“…ASM, anterior scalene muscle; MSM, middle scalene muscle; SCMM, sternocleidomastoid muscle; *, target for local anesthetic injection. Reproduced with permission from Aliste et al 10 .…”

Section: Methodsmentioning

confidence: 99%

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Randomized comparison between interscalene and costoclavicular blocks for arthroscopic shoulder surgery

Aliste

Bravo

Layera

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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BackgroundThis randomized trial compared ultrasound-guided interscalene block (ISB) and costoclavicular brachial plexus block (CCB) for arthroscopic shoulder surgery. We hypothesized that CCB would provide equivalent analgesia to ISB 30 min after surgery without the risk of hemidiaphragmatic paralysis.MethodsAll 44 patients received an ultrasound-guided block of the intermediate cervical plexus. Subsequently, they were randomized to ISB or CCB. The local anesthetic agent (20 mL of levobupivacaine 0.5% and epinephrine 5 µg/mL) and pharmacological block adjunct (4 mg of intravenous dexamethasone) were identical for all study participants. After the block performance, a blinded investigator assessed ISBs and CCBs every 5 min until 30 min using a composite scale that encompassed the sensory function of the supraclavicular nerves, the sensorimotor function of the axillary nerve and the motor function of the suprascapular nerve. A complete block was defined as one displaying a minimal score of six points (out of a maximum of eight points) at 30 min. Onset time was defined as the time required to reach the six-point minimal composite score. The blinded investigator also assessed the presence of hemidiaphragmatic paralysis at 30 min with ultrasonography.Subsequently, all patients underwent general anesthesia. Postoperatively, a blinded investigator recorded pain scores at rest at 0.5, 1, 2, 3, 6, 12, and 24 hours. Patient satisfaction at 24 hours, consumption of intraoperative and postoperative narcotics, and opioid-related side effects (eg, nausea/vomiting, pruritus) were also tabulated.ResultsBoth groups displayed equivalent postoperative pain scores at 0.5, 1, 2, 3, 6, 12, and 24 hours. ISB resulted in a higher incidence of hemidiaphragmatic paralysis (100% vs 0%; P < 0.001) as well as a shorter onset time (14.0 (5.0) vs 21.6 (6.4) minutes; p<0.001). However, no intergroup differences were found in terms of proportion of patients with minimal composite scores of 6 points at 30 min, intraoperative/postoperative opioid consumption, side effects, and patient satisfaction at 24 hours.ConclusionCompared to ISB, CCB results in equivalent postoperative analgesia while circumventing the risk of hemidiaphragmatic paralysis. Further confirmatory trials are required. Future studies should also investigate if CCB can provide surgical anesthesia for arthroscopic shoulder surgery.Clinical Trials RegistrationNCT03411343.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Randomized comparison between interscalene and costoclavicular blocks for arthroscopic shoulder surgery

Aliste

Bravo

Layera

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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“…Since most distal nerve blocks for shoulder surgery usually result in inferior analgesia in the immediate postoperative period, the primary outcome of this study was the patient discomfort score in the PACU at 30 min. Assuming a noninferiority margin of 1.5 points and a standard deviation (SD) of 1.7 based on a previous study [4], the necessary sample size for α = 0.05 and 80% power was calculated to be 16 patients. To allow for possible dropouts, we included 20 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Several diaphragm-sparing nerve blocks such as C7 nerve root block, [2] supraclavicular brachial plexus block [3,4], and distal nerve blocks have been investigated [5,6]. While supraclavicular brachial plexus block provided similar analgesia compared to ISB for shoulder surgery [3,4], most distal nerve blocks are less effective compared to ISB, especially immediate postoperative period [5][6][7]. An alternative to ISB is combined proximal suprascapular nerve block (SSNB) and costoclavicular brachial plexus block (CCB).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of combined suprascapular nerve and costoclavicular brachial plexus block for arthroscopic shoulder surgery: a prospective observational study

Kim¹,

Lee²,

Kim³

et al. 2019

Preprint

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Background Although interscalene brachial plexus block provides effective anesthesia and analgesia for shoulder surgery, one major drawback of interscalene brachial plexus block is ipsilateral phrenic nerve palsy. Several diaphragm-sparing nerve blocks have been suggested. We prospectively evaluated the effectiveness of combined suprascapular nerve and costoclavicular brachial plexus block for postoperative analgesia following arthroscopic shoulder surgery.Methods Nineteen patients scheduled for arthroscopic shoulder surgery received combined ultrasound-guided suprascapular nerve and costoclavicular brachial plexus block. Pain scores, use of supplemental analgesia, incidence of phrenic nerve palsy, block-related outcomes, patient satisfaction, and adverse effects were assessed.Results The block was successful in 17 patients (89.5%). Postoperative pain control was effective during the first 24 h after surgery. Phrenic nerve palsy did not occur (0%, 95% confidential interval 0 – 17%). There were no severe adverse events. Patients reported a high degree of satisfaction.Conclusion Combined suprascapular nerve and costoclavicular brachial plexus block provided effective postoperative analgesia for arthroscopic shoulder surgery without causing phrenic nerve palsy.

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Axillary Nerve Blockade

Gomez¹,

Peng

2022

Regional Nerve Blocks in Anesthesia and Pain Therapy

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A Randomized Comparison Between Interscalene and Small-Volume Supraclavicular Blocks for Arthroscopic Shoulder Surgery

Abstract: This study was registered at ClinicalTrials.gov, identifier NCT03224884.

Cited by 38 publications

References 22 publications

Randomized comparison between interscalene and costoclavicular blocks for arthroscopic shoulder surgery

Randomized comparison between interscalene and costoclavicular blocks for arthroscopic shoulder surgery

Effectiveness of combined suprascapular nerve and costoclavicular brachial plexus block for arthroscopic shoulder surgery: a prospective observational study

Axillary Nerve Blockade

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