Suprascapular Nerve Blockade for Postoperative Pain Control After Arthroscopic Shoulder Surgery: A Systematic Review and Meta-analysis

Abstract

Background:Regional nerve blocks are commonly used to manage postoperative pain after arthroscopic shoulder procedures. The interscalene brachial plexus block (ISB) is commonly used; however, because of the reported side effects of ISB, the use of a suprascapular nerve block (SSNB) has been described as an alternative strategy with fewer reported side effects.Purpose:To examine the efficacy of SSNB for pain control after shoulder arthroscopy compared with ISB as well as anesthesia without a nerve block.Study Design:Systematic review; Level of evidence, 1.Methods:Three databases (PubMed, MEDLINE, and EMBASE) were searched on April 20, 2018, to systematically identify and screen the literature for randomized controlled trials (RCTs). A meta-analysis of standard mean differences (SMDs) was performed to pool the estimated effects of the nerve blocks.Results:The search identified 14 RCTs that included 1382 patients, with a mean age of 54 years (SD, 13 years). The mean follow-up time was 3 days (range, 24 hours to 6 weeks). Postoperative pain control was significantly more effective in the SSNB groups compared with the control groups within 1 hour (SMD, –0.76; 95% CI, –1.45 to –0.07; P = .03) and 4 to 6 hours (SMD, –0.81; 95% CI, –1.53 to –0.09; P = .03) postoperatively. However, pain control was significantly less effective in the SSNB groups compared with ISB within 1 hour (SMD, 0.87; 95% CI, 0.28 to 1.46; P = .004). No major complications were noted in the SSNB groups, and minor complications such as hoarseness and prolonged motor block were significantly less common for SSNB compared with ISB.Conclusion:Although not more efficacious than ISB in terms of pain control for patients undergoing shoulder arthroscopy, SSNB provides significantly improved pain control in comparison with analgesia without a nerve block. Moreover, few major and minor complications are associated with SSNB reported across the literature.

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

“…First, the inclusion standard is different. One meta-analysis by Kay [ 22 ] compared SSNB with ISB as well as anesthesia without a nerve block. Another meta-analysis by Hussain [ 19 ] included comparison of SSNB plus AXB and ISB.…”

Pain Control After Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials With a Network Meta-analysis

“…87 Although we did not evaluate it in our study, the choice of nerve blocks may affect postoperative complications, with suprascapular block being associated with significantly fewer complications than ISB, including the rebound pain phenomenon. 47 Other nerve blocks are newer and promising with similar results, although 1 (supraclavicular block) is primarily used in elbow and hand surgery, given the nerve distribution. The addition of nerve block adjuncts was shown to provide prolonged pain control, with a few studies showing overall superior pain control.…”

“…98 Additionally, multidisciplinary input is required with anesthesiology involvement, as the mainstay modality for reducing immediate postoperative pain is regional anesthesia. 37,47,98 Other modalities include oral medications, nerve block adjuncts, cryotherapy, and electrical stimulation, as well as the increasing and often overlooked role of patient education. 91 Warrander et al 98 performed a systematic review in March 2015, in which they evaluated pain control methods after shoulder arthroscopy.…”

Continuous suprascapular nerve block compared with single-shot interscalene brachial plexus block for pain control after arthroscopic rotator cuff repair

“…SSNB is an effective alternative method of regional nerve block in shoulder surgery (11,12). SSNB provides superior analgesia compared to placebo or local anesthetic infiltration and is considered noninferior compared to ISNB (13)(14)(15)(16). The main advantage of SSNB is that it results in fewer adverse effects than ISNB, especially in hemidiaphragmatic palsy (13)(14)(15)(16).…”

“…SSNB provides superior analgesia compared to placebo or local anesthetic infiltration and is considered noninferior compared to ISNB (13)(14)(15)(16). The main advantage of SSNB is that it results in fewer adverse effects than ISNB, especially in hemidiaphragmatic palsy (13)(14)(15)(16). Additionally, the catheter lies deep in the muscle layer and does not easily migrate, even when the patient's neck moves (17,18).…”