Selective Suprascapular and Axillary Nerve Block Versus Interscalene Plexus Block for Pain Control After Arthroscopic Shoulder Surgery

Neuts, Anneleen; Stessel, Björn; Wouters, Patrick; Dierickx, Carl; Cools, Wilfried; Ory, J. P.; Dubois, Jasperina; Jamaer, Luc; Arijs, Ingrid; Schoorens, Dirk

doi:10.1097/aap.0000000000000777

Cited by 47 publications

(63 citation statements)

References 21 publications

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“…Ten millilitres is a high volume and there is likely to have been local anaesthetic spread to the phrenic nerve with this volume. Nevertheless, it corresponds with the literature regarding suprascapular nerve blocks . Further studies using lower volume (e.g.…”

Section: Discussionsupporting

confidence: 85%

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Hemidiaphragmatic paralysis following ultrasound‐guided anterior vs. posterior suprascapular nerve block: a double‐blind, randomised control trial

et al. 2020

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Summary Interscalene brachial plexus block provides analgesia for shoulder surgery but is associated with hemidiaphragmatic paralysis. Before considering a combined suprascapular and axillary nerve block as an alternative to interscalene brachial plexus block, evaluation of the incidence of diaphragmatic dysfunction according to the approach to the suprascapular nerve is necessary. We randomly allocated 84 patients undergoing arthroscopic shoulder surgery to an anterior or a posterior approach to the suprascapular nerve block combined with an axillary nerve block using 10 ml ropivacaine 0.375% for each nerve. The primary outcome was the incidence of hemidiaphragmatic paralysis diagnosed by ultrasound. Secondary outcomes included: characterisation of the hemidiaphragmatic paralysis over time; numeric rating scale pain scores; oral morphine equivalent consumption; and patient satisfaction. The incidence of hemidiaphragmatic paralysis was 40% (n = 17) vs. 2% (n = 1) in the anterior and posterior groups, respectively (p < 0.001). In one third of patients with hemidiaphragmatic paralysis, it persisted beyond the eighth hour. The median (interquartile range [range]) oral morphine equivalent consumption was significantly higher in the posterior approach when compared with the anterior approach, whether in the recovery area (20 [5–31 (0–60)] mg vs. 7.5 [0–14 (0–52)] mg, respectively; p = 0.004) or during the first 24 h (82 [61–127 (12–360) mg] vs. 58 [30–86 (0–160)] mg, respectively; p = 0.01). Patient satisfaction was comparable between groups (p = 0.6). Compared with the anterior approach, diaphragmatic function is best preserved with the posterior needle approach to the suprascapular nerve block.

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Section: Discussionsupporting

confidence: 85%

“…The suprascapular and axillary nerves provide sensory innervation to most of the glenohumeral joint [14][15][16]. Therefore, a combined suprascapular and axillary nerve block is a valid alternative to interscalene brachial plexus block [4] with less impact on respiratory function [17][18][19][20][21][22] and hand-grip strength [23].…”

Section: Introductionmentioning

confidence: 99%

Hemidiaphragmatic paralysis following ultrasound‐guided anterior vs. posterior suprascapular nerve block: a double‐blind, randomised control trial

et al. 2020

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“…Thus, ISB is not suitable for patients with chronic respiratory diseases such as chronic obstructive pulmonary disease or diffuse parenchymal lung disease (see Introduction, Verelst and van Zundert, ). Multiple studies have reported a wide range of outcomes of the combined approach (Price et al, ; Pitombo et al, ; Dhir et al, ; Neuts et al, ). Early‐stage analgesic success seems to be lower for this technique than for ISB (Pitombo et al, ; Dhir et al, ; Neuts et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…In many cases, the nerve branch innervating the shoulder joint (called the joint nerve—JN—by some authors) arises directly from the main nerve in the first segment adjacent to the SSM (Duparc et al, ). This pattern, with early detachment of the JN from the AN, could imply that a posterior injection approach, like the one usually employed for the AN blockade (Rothe et al, ; Pitombo et al, ; Dhir et al, ; Neuts et al, ), reaches the AN after fibers directed toward the articular capsule leave the main nerve, which would result in incomplete anesthesia. In fact, failure rates for posterior blockades have been reported to be as high as 41.4% (Dhir et al, ).…”

Section: Introduction and Aimsmentioning

confidence: 99%

Ultrasonography‐guided anterior approach for axillary nerve blockade: An anatomical study

et al. 2019

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Combined ultrasound (US)-guided blockade of the suprascapular and axillary nerves (ANs) has been proposed as an alternative to interscalene blockade for pain control in shoulder joint pathology or postsurgical care. This technique could help avoid respiratory complications and/or almost total upper limb palsy. Nowadays, the AN blockade is mostly performed using an in-plane caudal-to-cephalic approach from the posterior surface of the shoulder, reaching the nerve immediately after it exits the neurovascular quadrangular space (part of the spatium axillare). Despite precluding most respiratory complications, this approach has not made postsurgical pain relief any better than an interscalene blockade, probably because articular branches of the AN are not blocked.Cephalic-to-caudal methylene blue injections were placed in the first segment of the AN of six Thiel-embalmed cadavers using an US-guided anterior approach in order to compare the distribution with that produced by a posterior approach to the contralateral AN in the same cadaver. Another 21 formalin-fixed cadavers were bilaterally dissected to identify the articular branches of the AN.We found a good spread of the dye on the AN and a constant relationship of this nerve with the subscapularis muscle. The dye reached the musculocutaneous nerve, which also contributes to shoulder joint innervation. We describe the anatomical landmarks for an ultrasonography-guided anterior AN blockade and hypothesize that this anterior approach will provide better pain control than the posterior approach owing to complete blocking of the joint nerve. Clin. Anat. 33:488-499, 2020.

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“…Therefore, regional anesthetic methods are frequently preferred as part of multimodal analgesia to provide better pain control and to reduce the side effects associated with opioids [3]. In shoulder arthroplasty, isolated nerve blocks such as suprascapular and axillary nerve blocks for postoperative analgesia are frequently applied as well as the brachial plexus blocks from the costoclavicular, supraclavicular, and interscalene regions [1,[4][5]. Interscalene brachial plexus block (ISBPB) is accepted as the gold standard in shoulder surgery.…”

Section: Introductionmentioning

confidence: 99%

Does the Serratus Plane Block Added to the Interscalene Block Improve the Quality of Anesthesia in Arthroscopic Shoulder Surgery? A Prospective Randomized Study

Demir¹,

Yayık²,

Köse³

et al. 2020

Cureus

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Selective Suprascapular and Axillary Nerve Block Versus Interscalene Plexus Block for Pain Control After Arthroscopic Shoulder Surgery

Abstract: This study was registered at ClinicalTrials.gov, identifier NCT02415088.

Cited by 47 publications

References 21 publications

Hemidiaphragmatic paralysis following ultrasound‐guided anterior vs. posterior suprascapular nerve block: a double‐blind, randomised control trial

Hemidiaphragmatic paralysis following ultrasound‐guided anterior vs. posterior suprascapular nerve block: a double‐blind, randomised control trial

Ultrasonography‐guided anterior approach for axillary nerve blockade: An anatomical study

Does the Serratus Plane Block Added to the Interscalene Block Improve the Quality of Anesthesia in Arthroscopic Shoulder Surgery? A Prospective Randomized Study

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