Suprascapular block associated with supraclavicular block: An alternative to isolated interscalene block for analgesia in shoulder instability surgery?

Trabelsi, W.; Gabsia, A. Ben; Lebbi, A.; Sammoud, W.; Labbène, Iheb; Ferjani, Mustapha

doi:10.1016/j.otsr.2016.10.012

Cited by 21 publications

(27 citation statements)

References 21 publications

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“…In contrast, the subscapular nerve is now recognized as a major contributor to the anterior superior quadrant of the shoulder joint, while the axillary nerve innervates the inferior half of the joint. 12 This realization of the limited analgesic role of the posterior suprascapular block has prompted researchers to investigate supplementary blocks, such as supraclavicular 46 and infraclavicular 47 blocks, to combine with the posterior suprascapular block to match the analgesic effect of interscalene block. A superior trunk block per se may also be an option, but its proximity to the phrenic nerve and lack of knowledge of its respiratory effects favor more distal alternatives.…”

Section: Discussionmentioning

confidence: 99%

Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery

et al. 2020

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Background: Interscalene brachial plexus block, the pain relief standard for shoulder surgery, is an invasive technique associated with important complications. The subomohyoid anterior suprascapular block is a potential alternative, but evidence of its comparative analgesic effect is sparse. The authors tested the hypothesis that anterior suprascapular block is noninferior to interscalene block for improving pain control after shoulder surgery. As a secondary objective, the authors evaluated the success of superior trunk (C5-C6 dermatomes) block with suprascapular block. Methods:In this multicenter double-blind noninferiority randomized trial, 140 patients undergoing shoulder surgery were randomized to either interscalene or anterior suprascapular block with 15 ml of ropivacaine 0.5% and epinephrine. The primary outcome was area under the curve of postoperative visual analog scale pain scores during the first 24 h postoperatively. The 90% CI for the difference (interscalene-suprascapular) was compared against a -4.4-U noninferiority margin. Secondary outcomes included presence of superior trunk blockade, pain scores at individual time points, opioid consumption, time to first analgesic request, opioid-related side-effects, and quality of recovery.Results: A total of 136 patients were included in the analysis. The mean difference (90% CI) in area under the curve of pain scores for the (interscalene-suprascapular) comparison was -0.3 U (-0.8 to 0.12), exceeding the noninferiority margin of -4.4 U and demonstrating noninferiority of suprascapular block. The risk ratio (95% CI) of combined superior trunk (C5-C6 dermatomes) blockade was 0.98 (0.92 to 1.01), excluding any meaningful difference in superior trunk block success rates between the two groups. When differences in other analgesic outcomes existed, they were not clinically important.conclusions: The suprascapular block was noninferior to interscalene block with respect to improvement of postoperative pain control, and also for blockade of the superior trunk. These findings suggest that the suprascapular block consistently blocks the superior trunk and qualify it as an effective interscalene block alternative. What We Already Know about This Topic• Interscalene brachial plexus block is a commonly used procedure for shoulder surgery, but it can be associated with important complications What This Article Tells Us That Is New• Subomohyoid anterior suprascapular block is noninferior to interscalene block in providing analgesia for the first 24 h after shoulder surgery • Subomohyoid anterior suprascapular block does not appear to differ significantly from interscalene block in terms of superior trunk blockade or overall quality of recovery T he ongoing quest for effective alternatives to the interscalene block of the brachial plexus for postoperative analgesia after shoulder surgery 1 has been prompted by the interscalene block's invasiveness 2,3 and undesirable respiratory side effects related to phrenic nerve block, 4 which restrict its use in certain population...

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Section: Discussionmentioning

confidence: 99%

Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery

et al. 2020

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“…3,4 One new study showed that the US-guided supraclavicular block, combined with a suprascapular block, was an effective alternative to the interscalene block for postoperative analgesia after shoulder instability surgery. 15 Recently, subsequent to the report by Cornish 19 about the spreading of a local anesthetic between interscalene muscles during USguided SCBB, a prospective study 12 confirmed that sole US-guided SCBB was as effective as US-guided ISBB for shoulder arthroscopy. A suprascapular nerve crosses deep in the omohyoid muscle in the supraclavicular region.…”

Section: Discussionmentioning

confidence: 96%

“…Thus, numerous alternative techniques have been investigated, but have been found to be nonequivalent analgesic methods when compared with ISBB . One new study showed that the US‐guided supraclavicular block, combined with a suprascapular block, was an effective alternative to the interscalene block for postoperative analgesia after shoulder instability surgery . Recently, subsequent to the report by Cornish about the spreading of a local anesthetic between interscalene muscles during US‐guided SCBB, a prospective study confirmed that sole US‐guided SCBB was as effective as US‐guided ISBB for shoulder arthroscopy.…”

Section: Discussionmentioning

confidence: 99%

“…The general opinion is that SCBB could be inadequate in blocking the suprascapular nerve, a shoulder joint primary nerve that originates from the C5–C6 (and possibly C4) nerve roots of the superior trunk of the brachial plexus. Recent studies have explored the efficacy of SCBB on shoulder surgery . However, the effects of SCBB on pain and quality of recovery after arthroscopic shoulder surgery remain uncorroborated.…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have explored the efficacy of SCBB on shoulder surgery. 15,16 However, the effects of SCBB on pain and quality of recovery after arthroscopic shoulder surgery remain uncorroborated. The aim of the present study was to compare the effects of US-guided single-shot SCBB to those of US-guided single-shot ISBB with respect to postoperative pain and quality of recovery after arthroscopic shoulder surgery.…”

Section: Introductionmentioning

confidence: 99%

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

Karaman

Aşçi

et al. 2018

Pain Practice

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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.

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Ultrasound Guided Brachial Plexus Block

Sharma

Credaroli

Vadivelu

et al. 2021

Ultrasound Fundamentals

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Suprascapular block associated with supraclavicular block: An alternative to isolated interscalene block for analgesia in shoulder instability surgery?

Abstract: NCT identifier: NCT02397330.

Cited by 21 publications

References 21 publications

Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery

Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery

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

Ultrasound Guided Brachial Plexus Block

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