Suprascapular nerve block and axillary nerve block versus interscalene nerve block for arthroscopic shoulder surgery

Abstract

Background:The interscalene brachial plexus block (ISB) is a commonly used nerve block technique for postoperative analgesia in patients undergoing shoulder arthroscopy surgery; however, it is associated with potentially serious complications. The use of suprascapular nerve block (SSNB) and axillary Nerve Block (ANB) has been reported as an alternative nerve block with fewer reported side effects for shoulder arthroscopy. This review aimed to compare the impact of SSNB and ANB with ISB during shoulder arthroscopy surgery.Methods:A meta-analysis was conducted to identify relevant randomized or quasirandomized controlled trials involving SSNB and ISB during shoulder arthroscopy surgery. We searched Web of Science, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CNKI, and Wanfang database from 2010 through August 2021.Results:We identified 641 patients assessed in 10 randomized or quasirandomized controlled trials. Compared with the ISB group, the SSNB+ANB group had higher visual analog scale or numerical rating scale in PACU (P = .03), 4 hour (P = .001),6 hour after the operation (P = .002), and lower incidence of complications such as Numb/Tingling (P = .001), Weakness (P <.00001), Horner syndrome (P = .001) and Subjective dyspnea (P = .002). No significant difference was found for visual analog scale or numerical rating scale 8 hour (P = .71),12 hour (P = .17), 16 hour (P = .38),1day after operation (P = .11), patient satisfaction (P = .38) and incidence of complications such as hoarseness (P = .07) and nausea/vomiting (P = .41) between 2 groups.Conclusion:Our high-level evidence has established SSNB+ ANB as an effective and safe analgesic technique and a clinically attractive alternative to interscalene block during arthroscopic shoulder surgery, especially for severe chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity. Given our meta-analysis's relevant possible biases, we required more adequately powered and better-designed randomized controlled trial studies with long-term follow-up to reach a firmer conclusion.

Ultrasound guided interscalene brachial plexus block

“…Moreover, SSNB does appear to reduce the risk of Horner syndrome, numbness, subjective dyspnea, and hoarseness [17]. Similar results in terms of analgesia and complications were found in another recent meta-analysis that compared the use of SSNB in combination with axillary nerve block (ANB) as an alternative to ISB during shoulder arthroscopy [18]. The supraclavicular block has also been successfully used for acute pain control following shoulder surgery as part of multimodal analgesia [19,20].…”

The upper extremity regional anaesthesia trifecta: three upper extremity nerve blocks for awake upper‐limb surgery in a patient with a history of contralateral pneumonectomy*

“…Many previous studies have already described the combination of a suprascapular block with an axillary brachial plexus block. A recent meta‐analysis of those studies concluded that the combination of the two is an effective and safe alternative to the interscalene brachial plexus block for patients with pulmonary compromise [5]. When comparing the anterior suprascapular, interscalene and supraclavicular nerve blocks using 15 ml of 0.5% ropivacaine for major arthroscopic shoulder surgery, Auyong and colleagues demonstrated successful C5–8 dermatomal shoulder coverage at 60 min, following the anterior suprascapular nerve block, although this was less than the interscalene block [6].…”

Recent updates on interscalene brachial plexus block for shoulder surgery

“…Theoretically, the shoulder block may spare pulmonary function and diaphragmatic movement. Compared with ISBPB, suprascapular and axillary nerve blocks reduced the incidence of hemidiaphragmatic paresis and pulmonary dysfunction, while providing similar postoperative analgesia [32][33][34][35].…”