Interscalene versus supraclavicular plexus block for the prevention of postoperative pain after shoulder surgery

Schubert, Ann-Kristin; Dinges, Hanns-Christian; Wulf, Hinnerk; Wiesmann, Thomas

doi:10.1097/eja.0000000000000988

Cited by 22 publications

(18 citation statements)

References 39 publications

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“…Previous studies on SCBs in relation to shoulder surgery have all used a volume of at least 15 ml. They consistently report analgesia comparable to an ISB with less impact on the phrenic and other collateral nerves 7–13,25 . It seems that this modified technique targeting the suprascapular and the axillary nerves has potential for phrenic and peripheral nerve sparing.…”

Section: Discussionmentioning

confidence: 91%

Single injection combined suprascapular and axillary nerve block: A randomised controlled non‐inferiority trial in healthy volunteers

Steen-Hansen

Madsen

Lange

et al. 2022

Acta Anaesthesiol Scand

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Background A shoulder block without lung affection is desirable. In this study, we compared a low versus a high volume of a modified supraclavicular brachial plexus block. We hypothesised that a low volume of local anaesthetic would provide non‐inferior block success rate with better preserved lung function. Methods Healthy volunteers were randomised to receive ultrasound guided 5 or 20 ml ropivacaine 0.5% at the departure of the suprascapular nerve from the brachial plexus. Primary outcome was successful shoulder block—defined as cutaneous sensory affection of the axillary nerve and motor affection of the suprascapular nerve (>50% reduction in external rotation force measured with dynamometry). We used a non‐inferiority margin of 20%. Secondary outcome was change in lung function measured with spirometry. Results Thirteen of 16 (81.3%; 95% confidence interval [CI] 57.0% to 93.4%) in the 5 ml group and 15 of 16 (93.8%; 95% CI 71.7% to 98.9%) in the 20 ml group had successful shoulder block (p = .6). The ratio of the event rates of the 20 ml (standard) and 5 ml (intervention) groups was (15/16)/(13/16) = 0.937/0.813 = 1.15 (95% CI 0.88 to 1.51). All mean reductions in lung function parameters were non‐significantly lower in the 5 ml group compared with the 20 ml group. Conclusion For our primary outcome, the 95% CI of the difference of event ratio included the non‐inferiority margin. We are therefore unable to conclude that 5 ml LA is non‐inferior to 20 ml LA with respect to block success rate.

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Section: Discussionmentioning

confidence: 91%

Single injection combined suprascapular and axillary nerve block: A randomised controlled non‐inferiority trial in healthy volunteers

Steen-Hansen

Madsen

Lange

et al. 2022

Acta Anaesthesiol Scand

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“…The supraclavicular brachial plexus block does gain popularity benefited from the application of ultrasonic visualization technology [ 17 , 18 ]. However, the optimal needling technique for the SB is remaining controversial.…”

Section: Discussionmentioning

confidence: 99%

Intertruncal versus classical approach to the ultrasound-guided supraclavicular brachial plexus block for upper extremity surgery: study protocol for a randomized non-inferiority trial

Luo

Cai

Xie

et al. 2022

Trials

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Background Ultrasound-guided intertruncal approach (IA) to the supraclavicular block (SB) is recently proposed as a new approach for local anesthetic (LA) injection in terms of the classical approach (CA) at the level of the first rib. The CA-SB has been proven to result in satisfying sensorimotor block, but associate with a high risk of intraneural injection. The aim of this randomized non-inferiority study is to explore whether IA-SB can obtain similar block dynamics, as the CA-SB, but avoiding an intraneural injection during the whole nerve block procedure. Methods The total 122 patients undergoing elective upper extremity surgery will be randomly allocated to receive either an IA-SB or a CA-SB using a double-injection (DI) technique. In the IA-SB group, a portion of LA (15 mL) is injected accurately to the intertruncal plane between the middle and lower trunks under real-time ultrasound guidance; then, the remaining volume (10 mL) is carefully distributed to the other intertruncal plane between the upper and middle trunks. In the CA-SB group, the DI technique will be carried out as described in Tran’s study. The primary outcome is the percentage of patients with a complete sensory blockade at 20 min with a predefined non-inferiority margin of − 5%. The secondary outcomes include the sensory-motor blockade of all 4 terminal nerves, onset times of the individual nerves within 30 min, block-related variables, and adverse events. Discussion The results will provide sensory-motor blockade-related parameters and safety of the ultrasound-guided intertruncal approach to the supraclavicular block, thereby promoting clinical practice. Trial registration Chinese Clinical Trial Registry ChiCTR2000040199. Registered on 25 November 2020

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“…HDP is usually well tolerated in healthy patients, but in cases of a severe respiratory history, HDP is poorly tolerated, and IBPB is contraindicated. Supraclavicular, suprascapular, or superior trunk blocks have been studied as alternatives to IBPB in arthroscopic shoulder surgery [42][43][44][45]. Although supraclavicular block is considered an acceptable choice, clinically similar to IBPB, its incidence of HDP is still up to 59% [46].…”

Section: Discussionmentioning

confidence: 99%

Diaphragmatic paralysis, respiratory function, and postoperative pain after interscalene brachial plexus block with a reduced dose of 10 ml levobupivacaine 0.25% versus a 20 ml dose in patients undergoing arthroscopic shoulder surgery: study protocol for the randomized controlled double-blind REDOLEV study

Oliver-Forniés

Lahuerta

Gomez

et al. 2021

Trials

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Background Arthroscopic shoulder surgery causes severe postoperative pain. An interscalene brachial plexus block provides adequate analgesia, but unintended spread of the local anesthetic administered may result in a phrenic nerve block, usually associated with a nonnegligible incidence of acute hemidiaphragmatic paralysis. The main purpose of this trial will be to analyze the incidence of hemidiaphragmatic paralysis ensuing after interscalene brachial plexus block in patients undergoing arthroscopic shoulder surgery administered a standard volume (20 ml) vs. a low volume (10 ml) of levobupivacaine 0.25%. Methods This will be a prospective double-blind randomized controlled single-center two-arm comparative trial. Forty-eight patients will be included. The primary goal will be to ultrasonographically determine the incidence of hemidiaphragmatic paralysis by calculating the diaphragmatic thickness ratio in each group. The secondary goals will be to compare the two arms in terms of (1) decrease in forced vital capacity and (2) in forced expiratory volume at 1 s by spirometry; (3) decrease in diaphragmatic excursion by ultrasound; (4) 24-h total intravenous morphine consumption; (5) time to first opioid request of a patient-controlled analgesia pump; and (6) postoperative complications. Discussion This trial will demonstrate that a low-volume interscalene brachial plexus block decreases hemidiaphragmatic paralysis following arthroscopic shoulder surgery according to spirometry and ultrasound measurements and does not provide inferior postoperative analgesia to the standard volume, as measured by opioid requirements. Trial registration EudraCT and Spanish Trial Register (REec) registration number: 2019-003855-12 (registered on 7 January 2020). ClinicalTrials.gov identification number: NCT04385966 (retrospectively registered on 8 May 2020). Ethics Committee approval: EC19/093 (18 December 2019).

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Interscalene versus supraclavicular plexus block for the prevention of postoperative pain after shoulder surgery

Cited by 22 publications

References 39 publications

Single injection combined suprascapular and axillary nerve block: A randomised controlled non‐inferiority trial in healthy volunteers

Single injection combined suprascapular and axillary nerve block: A randomised controlled non‐inferiority trial in healthy volunteers

Intertruncal versus classical approach to the ultrasound-guided supraclavicular brachial plexus block for upper extremity surgery: study protocol for a randomized non-inferiority trial

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