Comparison between analgesic effect of ultrasound guided interscalene block versus shoulder block versus suprascapular nerve block for arthroscopic shoulder surgery: A randomized controlled trial

Abstract

Background: Shoulder arthroscopy is associated with severe post-operative pain, which causes significant discomfort to the patient, interfering with recovery and rehabilitation. The aim of this work was to compare efficacy of intra and post operative analgesia of inter-scalene block (ISB), shoulder block (SHB) and suprascapular nerve block (SSNB) for shoulder arthroscopic surgeries. Methods: This prospective randomized controlled double blinded research was carried out on 90 cases, with American Society of Anesthesiologists (ASA) physical status I and II, admitted for shoulder arthroscopy under general anesthesia (GA). Cases were equally randomized to: Group I: underwent ISB by 20 ml of levobupivacaine 0.5%, group II: underwent SHB by 10 ml of levobupivacaine 0.5% was injected below the supraspinatus (SS) fascia and another 10 ml was injected at axillary nerve and group III: underwent SSNB by 10 ml of levobupivacaine 0.5%. All blocks were ultrasound guided, before induction of GA. Results: Visual Analogue Scale at 2, 4, 6, 12, 18 and 24 hr, number of cases required rescue analgesia and required fentanyl intraoperatively and intraoperative fentanyl consumption and postoperative meperidine consumption were significantly higher in SSNB versus groups ISB and SHB (P value < 0.05) and was insignificantly different between ISB and SHB. Time to first rescue analgesic requirement was significantly earlier in SSNB versus groups ISB and SHB (p<0.001) and was insignificantly different between ISB and SHB. Postoperative nausea and vomiting (PONV) were significantly higher in SSNB versus groups ISB and SHB (P= 0.031), hemi-diaphragmatic paralysis and Horner syndrome were significantly higher in ISB versus groups SHB and SSNB (p<0.001). Conclusions: Both SHB and ISB blocks have similar efficacy in hemodynamic stability, analgesia, incidence PONV and cases' satisfaction. SSNB group showed inferior results in these parameters versus both SHB and ISB. However, ISB was associated with more complications versus groups SHB and SSNB.