Analgesic benefits and clinical role of the posterior suprascapular nerve block in shoulder surgery: a systematic review, meta‐analysis and trial sequential analysis

Cho, N.; Kang, RyungA; McCartney, Colin J. L.; Pawa, Amit; Costache, I.; Rose, Peter D.; Abdallah, Faraj W.

doi:10.1111/anae.14858

Cited by 13 publications

(15 citation statements)

References 40 publications

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“…26 Indeed, we have come to realize that the posterior suprascapular block alone blocks only the posterior superior quadrant 26 of the shoulder joint, thus providing partial pain relief only. In fact, Cho et al 45 recently pooled the results of 10 trials comparing posterior suprascapular nerve block to placebo. Their meta-analysis revealed this block is only marginally better than placebo; and its analgesic effects on 24-h pain scores and opioid consumption were not clinically important.…”

Section: Discussionmentioning

confidence: 99%

Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery

et al. 2020

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Background: Interscalene brachial plexus block, the pain relief standard for shoulder surgery, is an invasive technique associated with important complications. The subomohyoid anterior suprascapular block is a potential alternative, but evidence of its comparative analgesic effect is sparse. The authors tested the hypothesis that anterior suprascapular block is noninferior to interscalene block for improving pain control after shoulder surgery. As a secondary objective, the authors evaluated the success of superior trunk (C5-C6 dermatomes) block with suprascapular block. Methods:In this multicenter double-blind noninferiority randomized trial, 140 patients undergoing shoulder surgery were randomized to either interscalene or anterior suprascapular block with 15 ml of ropivacaine 0.5% and epinephrine. The primary outcome was area under the curve of postoperative visual analog scale pain scores during the first 24 h postoperatively. The 90% CI for the difference (interscalene-suprascapular) was compared against a -4.4-U noninferiority margin. Secondary outcomes included presence of superior trunk blockade, pain scores at individual time points, opioid consumption, time to first analgesic request, opioid-related side-effects, and quality of recovery.Results: A total of 136 patients were included in the analysis. The mean difference (90% CI) in area under the curve of pain scores for the (interscalene-suprascapular) comparison was -0.3 U (-0.8 to 0.12), exceeding the noninferiority margin of -4.4 U and demonstrating noninferiority of suprascapular block. The risk ratio (95% CI) of combined superior trunk (C5-C6 dermatomes) blockade was 0.98 (0.92 to 1.01), excluding any meaningful difference in superior trunk block success rates between the two groups. When differences in other analgesic outcomes existed, they were not clinically important.conclusions: The suprascapular block was noninferior to interscalene block with respect to improvement of postoperative pain control, and also for blockade of the superior trunk. These findings suggest that the suprascapular block consistently blocks the superior trunk and qualify it as an effective interscalene block alternative. What We Already Know about This Topic• Interscalene brachial plexus block is a commonly used procedure for shoulder surgery, but it can be associated with important complications What This Article Tells Us That Is New• Subomohyoid anterior suprascapular block is noninferior to interscalene block in providing analgesia for the first 24 h after shoulder surgery • Subomohyoid anterior suprascapular block does not appear to differ significantly from interscalene block in terms of superior trunk blockade or overall quality of recovery T he ongoing quest for effective alternatives to the interscalene block of the brachial plexus for postoperative analgesia after shoulder surgery 1 has been prompted by the interscalene block's invasiveness 2,3 and undesirable respiratory side effects related to phrenic nerve block, 4 which restrict its use in certain population...

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Section: Discussionmentioning

confidence: 99%

Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery

et al. 2020

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“…However, the study showed only modest improvement of the VAS score, with no improvement in other parameters of functional scores or health-related quality of life at 4-weeks of injections. A recent systematic review demonstrated that SSNB is statistically, but not clinically, superior to control for the area under curve of pain VAS score with a mean difference of 1.01 cm, suggesting that SSNB produced only modest improvements in analgesic outcomes [ 14 ]. Although this finding is similar to our study, we found that the proximal approach was superior in terms of identifying the nerve and the use of US guidance, thereby obviously improving the accuracy, as compared to SSNB using landmark-guided (blind) posterior approach.…”

Section: Discussionmentioning

confidence: 99%

Proximal Approach of Ultrasound-guided Suprascapular Nerve Block: Comparison with Subacromial Steroid Injection

Bae

Kim

Lim

2019

Clin Shoulder Elbow

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Background: This study was undertaken to evaluate early clinical outcomes of ultrasound-guided suprascapular nerve block (SSNB) using a proximal approach, as compared with subacromial steroid injection (SA).Methods: This retrospective study included a consecutive series of 40 patients of SSNB and 20 patients receiving SA, from August 2017 to August 2018. The visual analogue scale (VAS), American Shoulder Elbow Surgeon’s score (ASES), University of California, Los Angeles score (UCLA), the 36 health survey questionnaire mental component summary (SF36-MCS), physical component summary (PCS), and range of motion (forward elevation, external rotation, and internal rotation) were assessed for clinical evaluations.Results: Compared with the baseline, VAS, and ranges of motion in the SSNB group significantly improved at the 4-week follow-up (VAS scores improved from 6.7 ± 1.6 to 4.3 ± 2.4, p<0.001; all ranges of motion p<0.05), while other variables showed no statistically significant differences. All clinical variables were significantly improved in the SA group (p<0.05). However, all clinical scores at the 4-week follow-up showed no significant difference between groups.Conclusions: Ultrasound-guided SSNB using proximal approach provides significant pain relief at 4-weeks after treatment, with statistically significant difference when compared with SA, suggesting that SSNB using proximal approach is a potentially useful option in managing shoulder pain. However, in the current study, it was less effective in improving shoulder function and health-related quality of life, compared with SA.

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“…We received some comments from Drs Heesen and Klimek claiming to detect some discrepancies in our recent manuscript and questioning the findings. Below are the replies to their points.…”

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confidence: 99%

Methods matter: a reply

Abdallah

2020

Anaesthesia

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Analgesic benefits and clinical role of the posterior suprascapular nerve block in shoulder surgery: a systematic review, meta‐analysis and trial sequential analysis

Cited by 13 publications

References 40 publications

Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery

Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery

Proximal Approach of Ultrasound-guided Suprascapular Nerve Block: Comparison with Subacromial Steroid Injection

Methods matter: a reply

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