A comparison of ultrasound‐guided interscalene and supraclavicular blocks for post‐operative analgesia after shoulder surgery

Kim, B. G.; Han, Jeong Uk; Song, Jang-Ho; Yang, Chun Woo; Lee, B. W.; Baek, Ji-Hyeon

doi:10.1111/aas.12864

Cited by 51 publications

(63 citation statements)

References 23 publications

(24 reference statements)

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“…In that study, postoperative pain scores were only assessed at 2 time points (PACU and 24 hours) and reported as nondifferent between groups, similar to our study's finding. Likewise, the time to first analgesic requirement was also similar for each group in both studies …”

Section: Discussionsupporting

confidence: 87%

“…22 However, recent studies have shown that the reduced volume and concentration of local anesthetic resulted in equivalent analgesia and increased patient satisfaction when compared to a traditional dose. 23,24 In another study, Kim et al 25 performed SCBB or ISBB with 20 mL 0.375% ropivacaine under US guidance as additional to general anesthesia in shoulder surgery and reported no statistically significant difference between groups regarding the duration of postoperative analgesia. In that study, 25 postoperative pain scores were only assessed at 2 time points (PACU and 24 hours) and reported as nondifferent between groups, similar to our study's finding.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Ultrasound‐Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Postoperative Pain Management After Arthroscopic Shoulder Surgery

Karaman

Aşçi

et al. 2018

Pain Practice

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Background The interscalene brachial plexus block (ISBB) is an effective procedure for minimizing postoperative opioid consumption and pain following arthroscopic shoulder surgery. The ultrasound (US)‐guided supraclavicular brachial plexus block (SCBB) seems to be an alternative technique for arthroscopic shoulder surgery. However, evidence is lacking regarding the impact of SCBB on postoperative pain management and recovery after arthroscopic shoulder surgery. The aim of this study was to compare the effects of SCBB with ISBB in terms of postoperative pain and quality of recovery after arthroscopic shoulder surgery. Methods A total of 62 adult patients scheduled for arthroscopic shoulder surgery under general anesthesia were randomized into 2 groups to receive either ISBB (IB group, n = 31) or SCBB (SB group, n = 29) with 20 mL of 0.25% bupivacaine under US guidance. Assessments included postoperative pain scores, additional analgesic requirement, timing of the first analgesic requirement, Quality of Recovery‐40 (QoR‐40) scores, block characteristics, and side effects. Results No significant differences were found between the 2 groups for pain scores (P = 0.34), timing of first analgesic requirement (P = 0.30), additional analgesic requirement (P = 0.34), or QoR‐40 scores (P = 0.13). The block characteristics regarding procedure time (P = 0.95), block failure, and onset time of sensory blockade (P = 0.33) were similar. Horner's syndrome occurred in 8 patients in the IB group and 1 patient in the SB group (P = 0.015). Conclusions This study showed that US‐guided SCBB is as effective as ISBB in reducing postoperative pain and improving the quality of recovery for arthroscopic shoulder surgery.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Comparison of Ultrasound‐Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Postoperative Pain Management After Arthroscopic Shoulder Surgery

Karaman

Aşçi

et al. 2018

Pain Practice

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“…In particular, supraclavicular brachial plexus block (SCBPB) is a cost-effective anesthetic technique that is associated with low medical costs and a short length of hospital stay 1. Although SCBPB first became a popular approach for surgery distal to the shoulder, it has recently been used to provide analgesia for shoulder surgery 2. However, SCBPB is associated with ipsilateral hemidiaphragmatic paralysis at an estimated incidence of 36%–67%,3which has been attributed to the proximity of the phrenic nerve to the brachial plexus in the neck and the location and direction of diffusion of the locally applied anesthetic.…”

Section: Introductionmentioning

confidence: 99%

Effect of local anesthetic volume (20 mL vs 30 mL ropivacaine) on electromyography of the diaphragm and pulmonary function after ultrasound-guided supraclavicular brachial plexus block: a randomized controlled trial

Bao

Huang

Feng

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesDiaphragmatic paralysis following supraclavicular brachial plexus block (SCBPB) is ascribed to phrenic nerve palsy. This study investigated the effect of 2 volumes of 0.375% ropivacaine on efficacy of block as a surgical anesthetic and as an analgesic and examined diaphragm compound muscle action potentials (CMAPs) and pulmonary function before and after SCBPB.MethodsEighty patients scheduled for removal of hardware for internal fixation after healing of an upper limb fracture distal to the shoulder were randomized to receive ultrasound-guided SCBPC for surgical anesthesia with 20 mL (Group A) or 30 mL (Group B) 0.375% ropivacaine. The latency and amplitude of diaphragm CMAPs and forced vital capacity (FVC), FVC% predicted, and forced expiratory volume in 1 s (FEV1) were measured before and 30 min after SCBPB.ResultsBlock success as primary anesthetic in addition to analgesia was 81% in Group A and 91% in Group B. There were no obvious differences in the effectiveness of analgesia between the two groups. The mean time to onset of motor block was significantly longer in Group A (8.1±2.7 min) than in Group B (5.4 ± 2.8 min; p<0.05). The mean amplitude of the diaphragm CMAP was significantly lower in Group B than in Group A (p=0.03). The changes in FVC (Group A, − 8.1% vs Group B, −16.5%), FVC% (Group A, −8.0% vs Group B, −17.1%), and FEV1 (Group A, −9.5% vs Group B, −15.2%) from pre-SCBPB to post-SCBPB were significantly less in Group A than in Group B (all p=0.03).ConclusionsThe incidence rates of phrenic nerve palsy and diaphragm paralysis were reduced, and lung function was less impaired in patients who received 20 mL vs 30 mL of 0.375% ropivacaine without any differences in block success. Selecting a lower volume of anesthetic for nerve block may be especially beneficial in obese patients or patients with cardiopulmonary disease.Trial registration numberChiCTR-IND-17012166.

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“…[9] In a study performed after this review Kim et al compared the analgesic efficacy and side effects of interscalene and supraclavicular blocks for shoulder surgery using 20 ml of 0.375% ropivaciane and found no difference in postoperative analgesia duration, pain scores; and supplemental analgesia. [10] Ryu et al, [11] compared the anesthetic properties of these two blocks using 12.5 ml 1% mepivacaine, and 12.5 ml of 7.5% ropivacaine for similar shoulder surgery procedures and concluded that ultrasound guided supraclavicular blocks can be performed as an alternative to ultrasound guided interscalene blocks in patients undergoing arthroscopic shoulder surgery. Although focused more on the incidence of phrenic palsy in the PHRENICUS trial Wiesmann et al, [12] found that the postoperative analgesic quality and additional analgesic requirements of continuous supraclavicular blockade using patient-controlled ropivacaine was similar to interscalene group.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Analgesia after Arthroscopic Shoulder Surgery: A Comparison of Single Shot Interscalene Block with Single Shot Supraclavicular Block

Koltka

Büget²,

Bingül³

et al. 2017

Agri

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SummaryObjectives: In arthroscopic rotator cuff surgery for postoperative analgesia opioids, nonsteroid analgesics, and local anesthetics can be used. This study aimed to compare the effectiveness, additional analgesic requirements, patients satisfaction, and complications of single-shot interscalene and supraclavicular blocks. Methods: After obtaining the ethics committee's approval and informed consent, 50 ASA I-II patients were randomized to either the interscalene (GISB) or supraclavicular (GSCB) group. Preoperatively, patients received an ultrasonography-guided block using 30 ml of 0.5% bupivacaine. In the postoperative period, morphine patient-controlled analgesia was administered as a 0.3-mg/h basal dose and 1-mg bolus dose, with a 20-min lockout time. Postoperative visual analog scale (VAS; 0-10 cm) scores of the patients were evaluated at 4, 8, 12, and 24 h postoperatively; additional analgesic requirements, adverse effects, and complications were recorded. Patient satisfaction (PS) scores were evaluated after 24 h. Results: VAS scores at 4 h were lower in the GSCB group than in the GISB group, and the VAS scores at 8, 12, and 24 h were lower in the GISB group than in the GSCB group, with no statistical significance. Additional analgesic requirements was 28% in the GISB group and 68% in the GSCB group (p < 0.05). Total morphine consumption was lower in the GISB group than in the GSCB group (18.95±9.2 mg vs. 30.6 ± 9.6 mg; p < 0.001). PS scores were higher in the GISB group than in the GSCB group (7.0±1.0 vs. 6.1±0.9; p < 0.01). Adverse effects and complication rates were similar in both the groups. In GISB group, seven patients (28%) had nausea/vomiting, whereas in the GSCB group, 12 patients (48%) had nausea/vomiting. This difference was statistically insignificant. Conclusion: Supraclavicular block can be considered as an alternative to interscalene block for arthroscopic shoulder surgery.Keywords: shoulder surgery, interscalene block, supraclavicular block, postoperative analgesia Özet Amaç: Artroskopik omuz cerrahisi hastalarında postoperatif analjezik olarak opioidler, nonsteroid analjezikler ve lokal anestetikler kullanılabilir. Çalışmamızda tek doz interskalen blokla tek doz supraklavikular bloğun postoperatif analjezik etkinliklerini karşılaştırılması amaçlandı. Gereç ve Yöntem: Etik kurul ve hastalardan izin alındıktan sonra interskalen (GİSB) veya supraklavikular blok (GSKB) uygulanması için kontrendikasyonu bulunmayan ASA I-II 50 hasta randomize olarak ikiye ayrıldı. İki gruba da preoperatif dönemde ultrason eşliğinde blok yapılarak 30 ml %0.5 bupivakain uygulandı. Postoperatif dönemde intravenöz morfin 0.3 mgr/saat infüzyon, 1 mgr bolus doz ve kilitli kalma süresi 20 dakika olacak şekilde hasta kontrollü analjezi uygulandı. Hastaların postoperatif vizuel analog skala (VAS: 0-10 cm) değerleri 4., 8., 12. ve 24. saatlerde sorgulandı, ek analjezik ihtiyaçları ve tekniğe bağlı yan etki ve komplikasyonlar kaydedildi. 24 saat sonunda hasta memnuniyeti (HM) sorgulandı. Bulgular: VAS değerlerine bak...

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A comparison of ultrasound‐guided interscalene and supraclavicular blocks for post‐operative analgesia after shoulder surgery

Cited by 51 publications

References 23 publications

Comparison of Ultrasound‐Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Postoperative Pain Management After Arthroscopic Shoulder Surgery

Comparison of Ultrasound‐Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Postoperative Pain Management After Arthroscopic Shoulder Surgery

Effect of local anesthetic volume (20 mL vs 30 mL ropivacaine) on electromyography of the diaphragm and pulmonary function after ultrasound-guided supraclavicular brachial plexus block: a randomized controlled trial

Postoperative Analgesia after Arthroscopic Shoulder Surgery: A Comparison of Single Shot Interscalene Block with Single Shot Supraclavicular Block

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