Clinical evaluation of post-operative analgesia comparing suprascapular nerve block and interscalene brachial plexus block in patients undergoing shoulder arthroscopic surgery

Abstract

Suprascapular nerve blockInterscalene block Anaesthesia Post-operative analgesia a b s t r a c t Background: Shoulder arthroscopic surgeries have a high incidence of severe post-operative pain significant enough to interfere with recovery and rehabilitation. A regional anaesthetic technique combined with general anaesthesia reduces intra-operative requirements of anaesthesia and provides a better post-operative pain relief. As the commonly employed technique of interscalene brachial plexus block (ISB) is associated with potential serious complications, suprascapular nerve block (SSB) can be used as a safer alternative. Methods and material: In this prospective study, 60 ASA 1 or 2 adult patients undergoing shoulder arthroscopic surgery were randomised into two groups -ISB and SSB. In group ISB, ISB with 20 ml of 0.5% bupivacaine mixed with 75 mg clonidine was given. In the SSB group SSB was given with 15 ml of 0.5% bupivacaine with 75 mg clonidine. Pain was assessed using visual analogue scale and verbal pain scale scores and time to first rescue analgesia was noted. We used Student's t test and Chi-square/Fisher Exact test and used a statistical software to compare data. Results: In the present study, the mean duration of analgesia was 2.53 AE 2.26 h in SSB group compared to 7.23 AE 6.83 h in group ISB ( p value < 0.05). Overall rescue analgesic §

Continuous suprascapular nerve block compared with single-shot interscalene brachial plexus block for pain control after arthroscopic rotator cuff repair

“…Many studies have confirmed the efficacy of these two methods compared to control, intravenous patient-controlled analgesia (IV-PCA), and local anesthetic infiltration ( 5-7 , 11 , 16 ,). Although many studies have compared the analgesic efficacy of SSNB and ISNB ( 2 , 17 , 21 , 27 - 39 ), this is the first study to compare C-SSNB and S-ISNB with rebound pain at 6-12 h after surgery as a primary endpoint.…”

“…The use of a catheter for SSNB has been reported in arthroscopic surgery ( 18 , 45 ). Although the optimal dose needs to be verified in the future, a continuous dose of 2 mL per hour was sufficient to cover the small space in the scapular notch ( 2 ). As expected, C-SSNB resulted in a gradual decrease in the pain score over time and provided effective analgesia for at least 24 h after the surgery.…”

“…The use of arthroscopy is popular because it decreases pain, shortens hospital stay, and improves patient satisfaction. However, immediate postoperative pain remains to be a problem in more than 40% of patients (1,2). To date, the most effective method in controlling postoperative pain in shoulder surgery is regional nerve blocks, such as the interscalene brachial plexus block (ISNB) and the suprascapular nerve block (SSNB) (1,3).…”

Diaphragm-sparing nerve blocks for shoulder surgery, revisited

“…The suprascapular nerve can be anesthetized using an anterior37 or posterior38 approach. Randomized trials conducted prior to 2017 have consistently found that, compared with ISB, suprascapular blocks result in higher pain scores in the immediate postoperative period (0–4 hours) 39–41. In contrast, all trials published since 2017 have concluded that suprascapular nerve blocks and ISBs provide similar analgesia and breakthrough analgesic consumption for arthroscopic16 29 as well as open20 shoulder surgery.…”

Randomised controlled trial of analgesic effectiveness of three different techniques of single-shot interscalene brachial plexus block using 20 mL of 0.5% ropivacaine for shoulder arthroscopy

“…suprascapular nerve block [5,6], a single interscalene block combined with a continuous intrabursal infusion [7], intraarticular [8,9] or subacromial [10] injection of local anaesthetics, or postoperative intravenous opioid administration with patient-controlled intravenous analgesia [11]. There have been attempts to prolong the duration of sensory block by adding different adjuvants to local anaesthetics used in interscalene brachial plexus block (IBPB), such as dexamethasone [12,13] or dexmedetomidine [14].…”