Pain Relief After Arthroscopic Shoulder Surgery: A Comparison of Intraarticular Analgesia, Suprascapular Nerve Block, and Interscalene Brachial Plexus Block

Abstract

In this prospective, randomized, blinded study, we assessed the analgesic efficacy of interscalene brachial plexus block (ISB), suprascapular nerve block (SSB), and intraarticular local anesthetic (IA) after arthroscopic acromioplasty. One-hundred-twenty patients were divided into 4 groups of 30. In Group SSB, the block was performed with 10 mL of 0.25% bupivacaine. In Group IA, 20 mL of 0.25% bupivacaine was administered intraarticularly at the end of surgery. In Group ISB, the block was performed with 20 mL of 0.25% bupivacaine. A control group was included for comparison. General anesthesia was administered to all patients. Patients were observed during the first 24 h. Pain scores, supplemental analgesia, satisfaction scores, and side effects were recorded at 4 and 24 h. No significant difference was observed between the IA and control groups. When compared with these groups, Groups SSB and ISB had significantly lower pain scores. At 4-h follow-up, better pain relief on movement was noted in Group ISB than in Group SSB. When compared with controls, a significant reduction in morphine consumption and a better satisfaction score were noted only in Group ISB. We conclude that ISB is the most efficient analgesic technique after arthroscopic acromioplasty. SSN block would be a clinically appropriate alternative.

The Proximal Approach in an Ultrasound-Guided Suprascapular Nerve Block

“…(1:200,000), 15) 0.25% bupivacaine과 epinephrine 5 mg/ml, 16) 0.25% bupivacaine과 epinephrine (1:200,000), 17) 0.5% bupivacaine, 18) 1% ropivacaine, 19) 0.5% ropivacaine과 epinephrine (1:200,000), 20) 0.5% …”

Local Anaesthesia Efficacy as Postoperative Analgesia for Open Shoulder Instability Surgery: A Prospective Randomised Controlled Study

“…It is worth mentioning that the local injection 20 minutes before intervention coupled with the use of long lasting anaesthetics [20][21][22], together with the addition of epinephrine [11,21], likely contributed to the overall positive results observed and by favouring absorption. As known the infiltration of the surgical site to favour a pre-emptive action, is the central feature of this technique eliminating generation and transmission of pain impulses at A-delta and C-type nerves and therefore nociceptive nerve endings from which they arise, and before central processing complicates matters [19,23].…”

“…Discordant results have been reported regarding local injection of anaesthetics in the intra-articular region for control of postoperative pain after shoulder surgery [3,8], similar to subacromial injection [5,9,10] and block of the suprascapular nerve [11].…”

Eficácia analgésica pós-operatória de diferentes volumes e massas de ropivacaína no bloqueio de plexo braquial pela via posterior

“…Control the pain is one of the main problems in those surgeries, since these procedures are associated with postoperative pain of great intensity and hard to be controlled 8,9 . Among the techniques more commonly employed for this purpose are the use of intravenous opioids associated or not with NSAIDs, the use of articular local anesthetic, suprascapular nerve block and cervical and brachial plexus blocks [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] . Among such techniques, brachial plexus block offers the best results on the analgesia 1,[3][4][5][20][21] .…”

“…From the techniques of brachial plexus block, the interscalene block is more commonly used 8,[10][11][12]25,26 . Recently, the posterior brachial plexus block, also known as paravertebral cervical block, has received wide attention [1][2][3]7,27,28 .…”