Purpose
To compare the clinical efficacy and safety of arthroscopy-guided continuous suprascapular
nerve block and ultrasound-guided continuous interscalene block in postoperative analgesia
in patients undergoing arthroscopic rotator cuff repair.
Methods
A prospective study was performed between March and November 2020. In total, 76 patients
were enrolled and divided into 2 groups: in the 38 patients of group 1 (arthroscopy-guided
continuous suprascapular nerve block), an indwelling catheter was introduced via the
Neviaser portal under arthroscopic view before closing the portal at the end of the
surgery; and in the 38 patients of group 2 (ultrasound-guided continuous interscalene
block), an indwelling catheter was inserted and directed toward the interscalene brachial
plexus prior to the surgery under ultrasound guidance. The primary outcome was the
pain score measured by the visual analog scale at postoperative 24 hours during admission.
Comparisons were conducted at different time points (postoperative 4, 8, 24, and 48
hours). The secondary outcome was any of these events: neurologic complications, such
as sensory/motor change in the upper extremities; hemidiaphragmatic paresis; dyspnea;
dysphonia; and Horner’s syndrome. Opioid usage until postoperative 3 weeks was compared
between the groups.
Results
The visual analog scale scores in groups 1 and 2 were comparable at each postoperative
time point (analysis of variance, P = .919; trends, P = .132). Neurologic deficits were more common in group 2 than in group 1 (8 vs 32
patients, P < .001). Decreased excursion of the diaphragm was more common in group 2 (partial
or complete paresis of the hemidiaphragm: 1 vs 29 patients, P < .001). Opioid consumption was similar in both groups (morphine milligram equivalents
per kilogram; 1.75 vs 1.55, P = .195).
Conclusions
Our findings show that arthroscopy-guided continuous suprascapular nerve block is
not inferior to ultrasound-guided continuous interscalene block for postoperative
pain control after arthroscopic rotator cuff repair while showing fewer temporary
neurologic complications.
Level of Evidence
Level II, prospective cohort study, interventional study.
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References
- Epidemiology, natural history, and indications for treatment of rotator cuff tears.Clin Sports Med. 2012; 31: 589-604
- Continuous subacromial bupivacaine infusion for postoperative analgesia after open acromioplasty and rotator cuff repair: Preliminary results.J Shoulder Elbow Surg. 2004; 13: 630-634
- Multimodal approach to postoperative pain control in patients undergoing rotator cuff repair.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1744-1748
- Analgesic effectiveness of nerve block in shoulder arthroscopy: Comparison between interscalene, suprascapular and axillary nerve blocks.Knee Surg Sports Traumatol Arthrosc. 2012; 20: 2573-2578
- Analgesic efficacy of ultrasound-guided interscalene block vs. supraclavicular block for ambulatory arthroscopic rotator cuff repair: A randomised noninferiority study.Eur J Anaesthesiol. 2019; 36: 778-786
- Supraclavicular or interscalene brachial plexus block for rotator cuff repair?.Anaesthesia. 2016; 71: 1492-1493
- Comparison of arthroscopically guided suprascapular nerve block and blinded axillary nerve block vs. blinded suprascapular nerve block in arthroscopic rotator cuff repair: A randomized controlled trial.Clin Orthop Surg. 2017; 9: 340-347
- Postoperative analgesia for shoulder surgery: A critical appraisal and review of current techniques.Anaesthesia. 2010; 65: 608-624
- Continuous interscalene block for ambulatory shoulder surgery.Best Pract Res Clin Anaesthesiol. 2002; 16: 295-310
- Continuous interscalene brachial plexus blockade provides good analgesia at home after major shoulder surgery—Report of four cases.Can J Anaesth. 2003; 50: 57-61
- Effects of arthroscopy-guided suprascapular nerve block combined with ultrasound-guided interscalene brachial plexus block for arthroscopic rotator cuff repair: A randomized controlled trial.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 2121-2128
- Suprascapular nerve block for chronic shoulder pain in rheumatoid arthritis.BMJ. 1989; 299: 1079-1080
- Suprascapular nerve block: A new approach for the management of frozen shoulder.Anaesthesia. 1992; 47: 120-124
- Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: A new modality?.Anesth Analg. 1997; 84: 1306-1312
- Efficacy of suprascapular nerve block compared with subacromial injection: A randomized controlled trial in patients with rotator cuff tears.J Shoulder Elbow Surg. 2019; 28: 430-436
- Suprascapular nerve block versus interscalene block as analgesia after arthroscopic rotator cuff repair: A randomized controlled noninferiority trial.Arthroscopy. 2016; 32: 2203-2209
- Comparison of analgesic efficacy between single interscalene block combined with a continuous intra-bursal infusion of ropivacaine and continuous interscalene block after arthroscopic rotator cuff repair.Clin Orthop Surg. 2009; 1: 48-53
- Current concepts and recent trends in arthroscopic treatment of large to massive rotator cuff tears: A review.Clin Shoulder Elbow. 2019; 22: 50-57
- Fatty degeneration of the muscles of the rotator cuff: Assessment by computed tomography versus magnetic resonance imaging.J Shoulder Elbow Surg. 1999; 8: 599-605
- Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging.Invest Radiol. 1998; 33: 163-170
- Assessment of tendon retraction in large to massive rotator cuff tears: A modified Patte's classification based on two coronal sections on preoperative MRI with higher specificity on predicting reparability.Arthroscopy. 2020;
- Refining the ultrasound-guided interscalene brachial plexus block: The superior trunk approach.Can J Anaesth. 2014; 61: 1098-1102
- CDC Guideline for prescribing opioids for chronic pain—United States, 2016.MMWR Recomm Rep. 2016; 65: 1-49
- Image quality improvement in cone-beam CT using the super-resolution technique.J Radiat Res. 2018; 59: 501-510
- Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block.Reg Anesth Pain Med. 2009; 34: 595-599
- Minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state after arthroscopic rotator cuff repair.Am J Sports Med. 2020; 48: 2650-2659
- A new technique for regional anesthesia for arthroscopic shoulder surgery based on a suprascapular nerve block and an axillary nerve block: An evaluation of the first results.Arthroscopy. 2008; 24: 689-696
- Superior trunk block provides noninferior analgesia compared with interscalene brachial plexus block in arthroscopic shoulder surgery.Anesthesiology. 2019; 131: 1316-1326
- A comparison of combined suprascapular and axillary nerve blocks to interscalene nerve block for analgesia in arthroscopic shoulder surgery: An equivalence study.Reg Anesth Pain Med. 2016; 41: 564-571
- Managing rebound pain after regional anesthesia.Korean J Anesthesiol. 2020; 73: 372-383
- Ropivacaine for ultrasound-guided interscalene block: 5 mL provides similar analgesia but less phrenic nerve paralysis than 10 mL.Can J Anaesth. 2011; 58: 1001-1006
- Pneumothorax post brachial plexus block guided by ultrasound: A case report.Rev Bras Anestesiol. 2012; 62: 741-747
- Diaphragm function after interscalene brachial plexus block: A double-blind, randomized comparison of 0.25% and 0.125% bupivacaine.J Shoulder Elbow Surg. 2013; 22: 381-386
- Adverse events associated with continuous interscalene block administered using the catheter-over-needle method: A retrospective analysis.BMC Anesthesiol. 2019; 19: 195
- Hemidiaphragmatic paresis during interscalene brachial plexus block: Effects on pulmonary function and chest wall mechanics.Anesth Analg. 1992; 74: 352-357
Article info
Publication history
Published online: May 10, 2021
Accepted:
April 23,
2021
Received:
December 21,
2020
Footnotes
See commentary on page 3238
H.K. and H-J.K. are co-first authors.
The authors declare no conflict of interest. No funding related to the subject of this article was received. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 by the Arthroscopy Association of North America
