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

Abstract

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.

Evaluation of the success of supraclavicular blockade performed under general anesthesia in arthroscopic surgery of the shoulder by using Perfusion Index

“…Recent studies have investigated the efficacy of SCB on surgery of the shoulder [29][30][31]. SCB has been shown to be an effective alternative to postoperative analgesia in surgery for shoulder instability [11,29].…”

Diaphragm-sparing nerve blocks for shoulder surgery, revisited

“…Since January 2017, 16 RCTs have investigated diaphragm-sparing nerve blocks for shoulder surgery14–29 (see online supplementary table 1 and figure 1). Overall, the quality of the trials was high (median Jadad score=3.5).…”

“…Supraclavicular block constitutes the most investigated alternative to ISB since 2017 (seven RCTs) 16–22. The majority of trials suggest that, compared with ISB, supraclavicular blocks result in similar pain control, breakthrough analgesic consumption and patient satisfaction 16–18 21 22.…”

“…Supraclavicular block constitutes the most investigated alternative to ISB since 2017 (seven RCTs) 16–22. The majority of trials suggest that, compared with ISB, supraclavicular blocks result in similar pain control, breakthrough analgesic consumption and patient satisfaction 16–18 21 22. Although supraclavicular blocks are associated with better preservation of pulmonary function,16 20 the incidence of HDP still exceeds 60% when LA is injected inside the neural cluster formed by the confluence of trunks and divisions of the brachial plexus 17.…”

“…Since 2017, the multiple trials comparing supraclavicular blocks and ISB for shoulder surgery have consistently confirmed analgesic parity between the two approaches as well as a prohibitive incidence of HDP (up to 60%) associated with supraclavicular blocks 16–21. In 2018, Aliste et al 22 compared ISB and SCB using Renes et al ’s technique.…”