Supraclavicular block versus interscalene brachial plexus block for shoulder surgery: A meta-analysis of clinical control trials

Guo, Chaowei; Ma, Jianxiong; Ma, Xinlong; Lü, Bin; Wang, Y.; Sun, Lei; Dong, Bin; Teng, Yanbin

doi:10.1016/j.ijsu.2017.07.098

Cited by 30 publications

(23 citation statements)

References 25 publications

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“…Studies comparing this combination have recently been published, but the results vary, often with inferior analgesic efficacy to ISB, 35 or limited early postoperative efficacy. 36…”

Section: Resultsmentioning

confidence: 99%

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

Cabaton

Nové-Josserand

Mercadal

et al. 2019

European Journal of Anaesthesiology

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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.

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“…Studies comparing this combination have recently been published, but the results vary, often with inferior analgesic efficacy to ISB, 35 or limited early postoperative efficacy. 36…”

Section: Resultsmentioning

confidence: 99%

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

Cabaton

Nové-Josserand

Mercadal

et al. 2019

European Journal of Anaesthesiology

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“…Intravenous dexamethasone typically results in prolonged block duration to 18 hours providing a very good acceptance of the outpatient procedure [11]. However, the interscalene block may lead to respiratory complications and the supraclavicular block has been described as a safe alternative technique [12,13].…”

Section: Discussionmentioning

confidence: 99%

Outpatient Latarjet Procedure: Early Complications and Feasibility Validation

Zilber

Raboudi

2019

OSMOAJ

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Background:The Latarjet procedure may be amenable to outpatient elective surgery as it is often performed on young and healthy patients. Thus, ambulatory surgery for Latarjet procedure is recently rapidly increasing in France with very few validation studies. This feasibility study presents early adverse events following outpatient Latarjet surgery compared to Latarjet surgery performed as an inpatient procedure. Hypothesis:There is no difference between outpatient or inpatient Latarjet procedure.Patients and Methods: Thirty patients operated on an outpatient basis and prospectively followed were compared to 30 patients operated on an inpatient basis. All procedures were performed by the same surgeon. Complication rates as well as clinical outcomes at one year were compared between groups.Results: Post-operative hematomas which did not require surgery occurred more frequently in outpatient group in which no drain was used. No other differences occurred between groups. All outpatients but one was satisfied with the procedure. Discusion:The latarjet procedure was found to be safe when performed on an outpatient basis. The addition of wax to the base of the coracoid seemed to diminish hematoma formation.

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“…Shoulder surgeries, especially arthroscopic procedures, cause significant postoperative pain in the first 24 hours following surgery [6]. The interscalene block [5], suprascapular nerve block with or without axillary nerve block, and supraclavicular block may be used depending on the type of surgery [7].…”

Section: Discussionmentioning

confidence: 99%

“…The intensity of the postoperative pain is related to the extent of the surgical intervention and tissue damage created by the extent of adhesiolysis [6]. Rotator cuff repair and debridement of damaged tissue may also cause intense pain.…”

Section: Discussionmentioning

confidence: 99%

Case Report Presentation of Ultrasound-guided Erector Spinae Plane Block in Shoulder Surgery: Three Patients and Two Different Results

Selvi

Tulgar

Özer

2018

Cureus

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Erector spinae block (ESPB) is an effective therapy for chronic shoulder pain. However, ESPB has not been used as a postoperative analgesia method in shoulder surgeries. In this case report, we report three patients undergoing shoulder surgeries that received ESPB preoperatively for postoperative analgesia. All patients had relief of preoperative pain and no associated motor block. Two of the patients manifested with low maximum pain scores (4/10, 3/10) on a numeric rating scale (NRS). The other patient reported a maximum pain score of 8/10 on NRS. While this patient’s shoulder mobility immediately improved after ESPB application, the ESPB did not provide adequate analgesia for the postoperative period. The use of the ESPB for acute postoperative analgesia after shoulder surgery is novel and clinically interesting. However, postoperative analgesia was not completely opioid-sparing. Consequently, the efficiency of ESPB at the level of T2 for postoperative analgesia should be considered for surgeries that involve the shoulder cap given the possible inadequate migration of local anesthetic into the cervical plexus. Clinicians should carefully consider an ESPB as a postoperative analgesic option when considering shoulder operations and the possibility for the incomplete spread of local anesthetic in targeted neural structures.

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Supraclavicular block versus interscalene brachial plexus block for shoulder surgery: A meta-analysis of clinical control trials

Abstract: The meta-analysis showed that ultrasound-guided SCB could become a feasible alternative technique to the ISB in shoulder surgery.

Cited by 30 publications

References 25 publications

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

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

Outpatient Latarjet Procedure: Early Complications and Feasibility Validation

Case Report Presentation of Ultrasound-guided Erector Spinae Plane Block in Shoulder Surgery: Three Patients and Two Different Results

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