Randomized, controlled trial comparing respiratory and analgesic effects of interscalene, anterior suprascapular, and posterior suprascapular nerve blocks for arthroscopic shoulder surgery

Abstract

BackgroundInterscalene brachial plexus block (ISB) provides excellent analgesia for arthroscopic shoulder surgeries but is associated with adverse effects including hemidiaphragmatic paresis. We aimed to compare the respiratory effects, forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) between suprascapular nerve block (SSB) and ISB.MethodsSixty patients were recruited and randomized into ISB, anterior SSB, and posterior SSB groups. FVC, FEV1, and diaphragmatic excursion were evaluated at baseline and 30 minutes after intervention. Blocks were performed under ultrasound guidance with 15 ml of 0.5% ropivacaine. Pain scores were assessed at 6, 12, and 24 hours postoperatively.ResultsThe ISB group showed a reduced FVC of 31.2% ± 17.5% (mean ± SD), while the anterior and posterior SSB groups had less reduction of 3.6% ± 18.6% and 6.8% ± 6.5%, respectively (P < 0.001). The ISB group showed more reduction in diaphragmatic excursion than the anterior and posterior SSB groups (median [IQR]): −85.7% (−95.3% to −63.3%) vs. −1.8% (−13.1% to 2.3%) and −1.2% (−8.8% to 16.8%), respectively (P < 0.001). The median pain scores (IQR) in the ISB and anterior SSB groups were lower than those in the posterior SSB group at 6 hours on movement: 0 (0–2), 1.8 (0–4.5) vs. 5 (2.5–8), respectively (P = 0.002). There was no significant difference in oxycodone consumption postoperatively.ConclusionsAnterior SSB preserves lung function and has a comparable analgesic effect as ISB. Thus, it is recommended for arthroscopic shoulder surgeries, especially in patients who have reduced lung function.

Comparison of Ultrasound-Guided Supra-scapular Plus Axillary Nerve Block with Interscalene Block for Postoperative Pain Management in Arthroscopic Shoulder Surgery; A Double-Blinded Randomized Open-Label Clinical Trial

“…The average time of the first analgesic request and its prescribed dosage on the first post-operation day showed no significant difference between the two groups. These findings are comparable with most earlier studies (12)(13)(14)(15)(16).…”

Suprascapular nerve block is a clinically attractive alternative to interscalene nerve block during arthroscopic shoulder surgery: a meta-analysis of randomized controlled trials

“…If still in pain, oral morphine sulfate (10 mg, 6 times a day). Ikemoto 2010 [ 20 ] Anatomic landmarks guided 2 mg/kg of 0.5% ropivacaine NA NA Jiang 2017 [ 21 ] Ultrasound guided 20 mL of 0.375% ropivacaine+5mg of dexamethasone If VAS > 4, 50 mg of pethidine IM If VAS > 4, 50 mg of pethidine IM Kumara 2016 [ 25 ] Electrophysiology-guided 20 mL of 0.5% bupivacaine with 75 mg of clonidine If VAS> 4, 75 mg of diclofenac IM If VAS> 4, 75 mg of diclofenac IM Li 2018 [ 28 ] Ultrasound guided 20 mL of 0.375% ropivacaine If VAS > 4, tramadol IV If VAS > 4, tramadol IV Lim 2020 [ 29 ] Ultrasound guided 15 ml of 0.5% ropivacaine Intravenous morphine (up to 0.2 mg/kg) Regular oral paracetamol 1 g every 6 h and etoricoxib 120 mg once daily Liu 2020 [ 30 ] Ultrasound guided 6 mL of 0.3% ropivacaine NA NA Mai 2019 [ 31 ] Ultrasound guided 20 mL of 0.375% ropivacaine+5 mg of dexamethasone NA NA Ovesen 2014 [ 34 ] Anatomic landmarks guided 20 mL of bupivacaine (SSNB)/30 mL of ropivacaine (ISB) NA 1 g of paracetamol 4 times a day, 600 mg of ibuprofen 3 times a day. If VAS > 3, patients received 3-5 mg nicomorphine hydrochloride IV followed by 5 mg ketobemidone.…”

Transparency considerations for describing statistical analyses in research

“…The studies by Lee et al [ 3 ] and Hervás et al [ 4 ] received scores of 2 for the “rationale for and details of the statistical analysis methods used” item because, although they stated that they used propensity score matching, no descriptions of the adjustment method, caliper value, or the ratio of pair-matching were found, which would significantly affect the results of the subsequent statistical analysis. Likewise, the papers by Lim et al [ 5 ] and Tamboli et al [ 6 ] reported performing statistical analyses without describing the rationale for and details of the statistical analysis methods used. Thus, they each received a score of 2 for this item.…”