Analgesic efficacy of ultrasound-guided interscalene block vs. supraclavicular block for ambulatory arthroscopic rotator cuff repair

Abstract

BACKGROUNDUltrasound-guided interscalene block (ISB) is the reference technique for pain control after ambulatory upper limb surgery, but supraclavicular block (SCB) is an alternative.OBJECTIVESThe aim of this study was to compare the efficacy of SCB vs. ISB in patients undergoing ambulatory arthroscopic rotator cuff repair (ARCR), with the hypothesis of noninferiority of SCB analgesia compared with ISB.DESIGNA randomised, single-blind, noninferiority study.SETTINGHôpital Privé Jean Mermoz, Centre Paul Santy, Lyon, France.PATIENTSAmbulatory ARCR patients.INTERVENTIONPatients were randomly allocated (1 : 1) to receive a single injection SCB or ISB, as well as general anaesthesia. All patients received a postoperative analgesic prescription for home use before leaving hospital (including fast-acting oral morphine sulphate). Patients completed a telephone questionnaire on days 1 and 2 postsurgery.MAIN OUTCOME MEASURESPrimary endpoint was oral morphine consumption (mg) during the first 2 days postsurgery. If the difference between mean morphine consumption in the SCB vs. ISB group was less than 30 mg, noninferiority of SCB compared with ISB would be demonstrated. Secondary evaluation criteria included pain scores (numerical rating scale), duration of motor and sensory blockade, and satisfaction with treatment.RESULTSThe per-protocol cohort included 103 patients (SCB = 52, ISB = 51) (57% men, median age 58 years). Mean morphine consumption in the 48 h postsurgery was 9.4 vs. 14.7 mg in the SCB and ISB groups, respectively (difference −5.3, P < 0.001). The upper limit of the 95% CI was less than 30 mg, demonstrating noninferiority of SCB compared with ISB. No difference was observed between the two groups in terms of pain scores or the duration of motor or sensory blockade. Overall, 98% of patients in the SCB group vs. 90% in the ISB group were satisfied with their treatment.CONCLUSIONSCB is as effective as ISB in terms of postoperative analgesia based on oral morphine consumption in patients undergoing ambulatory ARCR.TRIAL REGISTRATIONEudraCT number: 2016-A00747-47.

A Historical Analysis of Randomized Controlled Trials in the Management of Pain in Rotator Cuff Tears

“…By the final follow-up, 212 patients were lost. A total of 74 of the 79 studies were single-centered [ 1 , 2 , 5 , 6 , 7 , 8 , 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , ...…”

Postoperative Pain Control After Arthroscopic Rotator Cuff Repair: Arthroscopy-Guided Continuous Suprascapular Nerve Block Versus Ultrasound-Guided Continuous Interscalene Block

“…3 At the same time, considering the recent socioeconomic issues that there were a lot of trials to reduce hospitalization days and minimize opioid consumptions, regional block combined with general anesthesia was widely performed. 5,7 Also, there were reports that for reducing rebound pain, continuous nerve block using indwelling catheter was more effective than single. 8,9 Although ISB catheterization is one of the most effective methods, it can cause complications such as phrenic nerve palsy/pneumothorax and temporal brachial partial palsy.…”

“…3 Among them, nerve block for postoperative pain control, which includes interscalene block, supraclavicular block, and suprascapular nerve block, has been used extensively to reduce pain and side effects of medications. [4][5][6][7] In recent years, several studies have reported that continuous interscalene block (ISB) is effective in controlling postoperative pain and decreasing rebound pain. [8][9][10] ISB targets the C5 and C6 nerve roots of the brachial plexus, where the suprascapular nerve and axillary nerve innervate the shoulder joint.…”

Postoperative Multimodal Pain Management and Opioid Consumption in Arthroscopy Clinical Trials: A Systematic Review

“…Four studies evaluated nerve blocks for rotator cuff repair specifically. 32,37,44,87 Cabaton et al 37 found that a supraclavicular nerve block with 100 mg levobupivacaine and clonidine provided similar pain management but much less opioid consumption from 0 to 48 hours postoperatively compared to an ultrasound-guided interscalene nerve block with the same dosages. Wong et al 87 shows that an interscalene block with 20 mL of .2% ropivacaine decreases opioid consumption at 72 hours postoperatively compared to the same block with only .1% ropivacaine.…”