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

Koltka, Ahmet; Büget, Mehmet İlke; Bingül, Emre Sertaç; Erşen, Ali; Küçükay, Süleyman; Atalar, Ata Can; Şentürk, Mert

doi:10.5505/agri.2017.67984

Cited by 5 publications

(9 citation statements)

References 13 publications

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“…This technique advantageously numbs the branches of the suprascapular nerve, which supplies up to two-thirds (70%) of the sensory input to the glenohumeral joint, including the supraspinatus and infraspinatus muscles. According to this anatomical foundation, this technique has been advocated to provide adequate pain control, including equivalent analgesic effects to IBPB (30) during shoulder surgery (16). A recent RCT by Sayed et al showed that the addition of suprascapular nerve block to intraarticular injection of steroids or hyaluronic acid resulted in enhanced analgesic effects among patients with adhesive capsulitis of the shoulder (31).…”

Section: Summary Of Findingsmentioning

confidence: 99%

Efficacy of Liposomal Bupivacaine in Arthroscopic Rotator Cuff Repair: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Alaqaili¹,

Al-Saati²,

Alyousef³

et al. 2022

Muscle Ligaments and Tendons J

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Objective. To conduct the first-ever meta-analysis of all randomized controlled trials (RCTs) that scrutinized the analgesic efficacy of liposomal bupivacaine (LB, intervention) versus nonliposomal local anesthetic agents (NLAAs, control) during arthroscopic rotator cuff repair (ARCR). Methods. Five databases were screened from inception until 09-April-2022. Subgroup analyses according to the postoperative day (POD, POD 0-7) were conducted. The data were summarized as weighted mean difference (WMD) with 95% confidence interval (CI) under the random-effects model. Results. Seven RCTs comprising 442 patients were included. Three, three, and one RCT(s) were judged to have an overall "low", "high", and "unclear" risk of bias, respectively. Regarding overall VAS pain score, there was no significant difference between both groups (WMD = -0.56, 95% CI [-1.16, 0.04], p = 0.07). Subgroup analyses showed significantly reduced postoperative VAS pain scores in favor of the LB group on POD 1/2; however, these reductions were not clinically meaningful. Also, LB correlated with a significant reduction in overall postoperative opioid consumption (WMD = -7.72 MME, 95% CI [-11.48, -3.97], p < 0.001). Subgroup analyses showed a significantly reduced postoperative opioid consumption in favor of the LB group on POD 1/2/3; however, these reductions were not clinically meaningful. Conclusions. Among patients undergoing ARCR, this systematic review and meta-analysis of RCTs showed that LB did not correlate with clinically meaningful reductions in postoperative VAS pain scores and overall opioid consumption. Future large-sized and well-designed RCTs are needed to consolidate the presented evidence.

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Section: Summary Of Findingsmentioning

confidence: 99%

Efficacy of Liposomal Bupivacaine in Arthroscopic Rotator Cuff Repair: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Alaqaili¹,

Al-Saati²,

Alyousef³

et al. 2022

Muscle Ligaments and Tendons J

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“…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).…”

Section: Evidence Derived From Rcts Published Between January 2017 Anmentioning

confidence: 99%

“…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.…”

Section: Evidence Derived From Rcts Published Between January 2017 Anmentioning

confidence: 99%

“…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.…”

Section: Current Understanding Of Diaphragm-sparing Nerve Blocksmentioning

confidence: 99%

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Diaphragm-sparing nerve blocks for shoulder surgery, revisited

Tran

Layera

Bravo

et al. 2019

Reg Anesth Pain Med

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Although interscalene brachial plexus block (ISB) remains the gold standard for analgesia after shoulder surgery, the inherent risks of ipsilateral phrenic nerve block and hemidiaphragmatic paralysis (HDP) limit its use in patients with preexisting pulmonary compromise. In a previous Daring Discourse (2017), our research team has identified potential diaphragm-sparing alternatives to ISB for patients undergoing shoulder surgery. In recent years, the field has been fertile with research, with the publication of multiple randomized controlled trials investigating supraclavicular blocks, upper trunk blocks, anterior suprascapular nerve blocks, costoclavicular blocks, and combined infraclavicular-suprascapular blocks. To date, the cumulative evidence (pre-2017 and post-2017) suggests that costoclavicular blocks may provide similar postoperative analgesia to ISB coupled with a 0%-incidence of HDP. However, in light of the small number of patients recruited by the single study investigating costoclavicular blocks, further confirmatory trials are required. Moreover, future investigation should also be undertaken to determine if costoclavicular blocks could achieve surgical anesthesia for shoulder surgery. Anterior suprascapular nerve blocks have been demonstrated to provide surgical anesthesia and similar analgesia to ISB. However, their risk of HDP has not been formally quantified. Of the remaining diaphragm-sparing nerve blocks, supraclavicular blocks (with local anesthetic injection posterolateral to the brachial plexus), upper trunk blocks, and combined infraclavicular-anterior suprascapular blocks merit further investigation, as they have been shown to achieve similar analgesia to ISB, coupled with an HDP incidence <10%.

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“…Despite optimal postoperative pain management and patient satisfaction, cliniciansʹ risk of postoperative complications is still an important challenge. Many studies have been conducted to reveal which method is superior in postoperative pain control after arthroscopic rotator cuff operations (6,10,(16)(17)(18)(19). However, although the blocks performed at the surgical site and general anesthesia in shoulder arthroscopy are known to be safe, easy, and have lesser ÖZ Amaç: Cerrahi sonrası özellikle ilk 48 saatte görülen postoperatif ağrı önemli bir problemdir ve postoperatif ağrı kontrolünde çeşitli yöntemler kullanılmaktadır.…”

mentioning

confidence: 99%

The effect of general anesthesia and combined general and regional anesthesia on postoperative pain in arthroscopic rotator cuff surgery: a randomized controlled prospective study

Akçal¹,

Göksu²,

Bayar³

et al. 2021

Deu Med J

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Objective: Postoperative pain seen in the first 48 hours after surgery, is an important problem and various methods are used in postoperative pain control. This study aims to investigate the effects of general anesthesia and combined general and regional anesthesia use on postoperative pain in arthroscopic rotator cuff repair operations.Materials and Methods: Twenty-eight female patients who were planned for arthroscopic rotator cuff surgery were included. The patients were randomly divided into two groups. Scalene block was applied to patients in Group 1 (n=14) in addition to general anesthesia while the patients in Group 2 (n=14) received only general anesthesia. Pain levels of the groups at the sixth, 12th, and 24th hours were evaluated with the Visual Analogue Scale (VAS). The findings were analyzed with Student's-t test and Mann-Whitney U test using SPSS 18.0 statistical program. Results:The average age of the Group 1 was 57 (45 ± 68); and the average age of the patients in Group 2 was 57.93 (47 ± 69). The postoperative pain levels of Group 1 was 1.57 (± 1.74) at the 6th hour; 2.57 (± 1.28) at the 12th hour, 2.71 (± 1.20) at the 24th hour; in Group 2 the 6th hour pain level was 8.00 (± 1.75); 12th hour level was 7.00 (± 1.52); and it was 6.00 (± 1.57) at the 24th hour. There was a statistically significant difference in all measurements in terms of VAS scores (p <0.001). Conclusion:It is concluded that implementation of scalene block in addition to general anesthesia, increases the success of the operation in arthroscopic rotator cuff repair surgery.

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

Cited by 5 publications

References 13 publications

Efficacy of Liposomal Bupivacaine in Arthroscopic Rotator Cuff Repair: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Efficacy of Liposomal Bupivacaine in Arthroscopic Rotator Cuff Repair: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Diaphragm-sparing nerve blocks for shoulder surgery, revisited

The effect of general anesthesia and combined general and regional anesthesia on postoperative pain in arthroscopic rotator cuff surgery: a randomized controlled prospective study

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