A randomised placebo-controlled trial examining the effect on hand supination after the addition of a suprascapular nerve block to infraclavicular brachial plexus blockade

Flohr-Madsen, Sandra; Ytrebø, Lars Marius; Valen, Katrin; Wilsgaard, Tom; Klaastad, Øivind

doi:10.1111/anae.13504

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…This clinical problem has recently received considerable attention, with several calls to seek alternatives to interscalene block in shoulder arthroscopy [ 9 ]. So, the need for a safer ISB alternative has prompted researchers to examine several options, including but not limited to the suprascapular block [ 14 ]. The suprascapular nerve block (SSNB) technique is a simple, easily reproducible technique that is thought to supply sensory fibers to approximately 70% of the shoulder joint and directly innervates the supraspinatus and infraspinatus muscles.…”

Section: Introductionmentioning

confidence: 99%

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

Sun

Zhang

et al. 2021

J Orthop Surg Res

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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) has been described as an alternative strategy with fewer reported side effects for shoulder arthroscopy. This review aimed to compare the impact of SSNB and ISB during shoulder arthroscopy surgery. Methods A meta-analysis was conducted to identify relevant randomized controlled trials involving SSNB and ISB during shoulder arthroscopy surgery. Web of Science, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CNKI, and Wanfang database were searched from 2010 through March 2021. Results We identified 1255 patients assessed in 17 randomized controlled trials. Compared with the ISB group, the SSNB group had higher VAS at rest in PACU (P = 0.003), 1 h after operation (P = 0.005), similar pain score 2 h (P = 0.39), 3-4 h (P = 0.32), 6-8 h after operation (P = 0.05), then lower VAS 12 h after operation (P = 0.00006), and again similar VAS 1 day (P = 0.62) and 2 days after operation (P = 0.70). As for the VAS with movement, the SSNB group had higher pain score in PACU (P = 0.03), similar VAS 4-6 h after operation (P = 0.25), then lower pain score 8-12 h after operation (P = 0.01) and again similar VAS 1 day after operation (P = 0.3) compared with the ISB group. No significant difference was found for oral morphine equivalents use at 24 h (P = 0.35), duration of PACU stay (P = 0.65), the rate of patient satisfaction (P = 0.14) as well as the rate of vomiting (P = 0.56), and local tenderness (P = 0.87). However, the SSNB group had lower rate of block-related complications such as Horner syndrome (P < 0.0001), numb (P = 0.002), dyspnea (P = 0.04), and hoarseness (P = 0.04). Conclusion Our high-level evidence established SSNB as an effective and safe analgesic technique and a clinically attractive alternative to interscalene block with the SSNB’S advantage of similar pain control, morphine use, and less nerve block-related complications 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 RCT studies with long-term follow-up to reach a firmer conclusion.

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Section: Introductionmentioning

confidence: 99%

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

Sun

Zhang

et al. 2021

J Orthop Surg Res

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“…To our knowledge, this is the first study that used surface electromyography to quantify the block of individual nerves after an infraclavicular brachial plexus block. Several studies have reported the effect of an infraclavicular brachial plexus block on the axillary nerve using different variations of simple sensory and motor tests, but only as secondary outcomes and results are conflicting, with rates ranging from 9% to 100% .…”

Section: Discussionmentioning

confidence: 99%

Effect of a lateral infraclavicular brachial plexus block on the axillary and suprascapular nerves as determined by electromyography – a cohort study

et al. 2018

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We aimed to examine to what extent a lateral infraclavicular brachial plexus block affected the axillary and the suprascapular nerve. We included patients undergoing hand surgery anaesthetised with a lateral infraclavicular brachial plexus block. Our primary outcome was the relative change in surface electromyography during maximum voluntary isometric contraction of the medial deltoid muscle (axillary nerve) and the infraspinatus muscle (suprascapular nerve) from baseline to 30 min after the block procedure. A reduction in electromyography of > 50% defined a successful block. The impact of the block on the shoulder nerves was compared with the surgical target nerves of the arm and hand (musculocutaneous, radial, median and ulnar nerves). Twenty patients were included. The medians of the relative changes in the surface electromyography were significantly reduced (both p< 0.001) with 92% for the deltoid muscle and 30% for the infraspinatus muscle, respectively. In total, 18 out of 20 patients had reductions > 50% for the deltoid muscle, which was significantly different from the infraspinatus muscle, where the proportion was 5 out of 20 (p < 0.001). The medians of the relative reductions in electromyography for the arm and hand muscles were 90-96%, similar to the effect on the deltoid muscle. Our results suggest that a lateral infraclavicular block provides block of the axillary nerve comparable to the block of the surgical target nerves. The suprascapular nerve is blocked to a lesser degree. Combining a lateral infraclavicular brachial plexus block with a selective suprascapular block for shoulder surgery warrants further studies.

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“…These data are corroborated by former studies where our infraclavicular method has been used. 3,4 Considering shoulder patients and the search for distal alternatives to interscalene block, we think that the results of the 3 studies support the idea of using infraclavicular blocks also to anesthetize the axillary nerve.…”

mentioning

confidence: 85%

The Effect of Infraclavicular Brachial Plexus Blocks on the Axillary Nerve

Musso

Flohr-Madsen

Ytrebø

et al. 2018

Regional Anesthesia and Pain Medicine

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A randomised placebo-controlled trial examining the effect on hand supination after the addition of a suprascapular nerve block to infraclavicular brachial plexus blockade

Cited by 7 publications

References 12 publications

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

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

Effect of a lateral infraclavicular brachial plexus block on the axillary and suprascapular nerves as determined by electromyography – a cohort study

The Effect of Infraclavicular Brachial Plexus Blocks on the Axillary Nerve

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