COMPARISON BETWEEN SUPRA-SCAPULAR NERVE BLOCK COMBINED WITH AXILLARY NERVE BLOCK AND INTERSCALENE BRACHIAL PLEXUS BLOCK FOR POSTOPERATIVE ANALGESIA FOLLOWING SHOULDER ARTHROSCOPY
Keywords:
Shoulder arthroscopy, suprascapular nerve block, axillary nerve block, interscalene brachial plexus block, postoperative analgesia, regional anesthesiaAbstract
ackground: After performing shoulder arthroscopy, a lot of pain persists after an operation; therefore, often there will be a need for regional anaesthetic blockade that is effective. To date, many have argued that the interscalene brachial plexus block has proven to be the best and the most reliable means of providing good postoperative pain control with the potential for complications such as diaphragmatic paralysis or respiratory deterioration. The Suprascapular +Axillary block would serve as a replacement method; providing similar, effective analgesic benefits without the potential complication of diaphragmatic paralysis. A comparative study of these two techniques would help establish the efficacy and safety of both techniques to patients who undergo shoulder arthroscopies. Aim: To compare the analgesic efficacy and safety of suprascapular nerve block combined with axillary nerve block with interscalene brachial plexus block for postoperative pain control following shoulder arthroscopy.
Methods: An 18-month prospective study was performed in the Anaesthesiology Department of a tertiary hospital in India comparing two techniques for shoulder arthroscopy performed under general anaesthesia. Eighty adult patients were randomized into two groups of 40 to receive either ultrasound-guided suprascapular nerve (combined with axillary) block (Group SA) or ultrasound-guided interscalene brachial plexus block (Group IS). Each group’s postoperative pain was evaluated with a 10cm visual analogue scale at multiple times up to 24 hours postoperatively; timing of first rescue analgesic administration, total perioperative analgesic consumption, and complication rates were recorded and analysed.
Results: Baseline demographic characteristics were comparable between both groups. Postoperative visual analogue scores were significantly lower in the interscalene block group during the immediate postoperative period up to sixth hourly for six hours. However, from 8-24 hours; pain scores were comparable between both groups. The mean time to first rescue analgesia was longer in the interscalene block group compared with the suprascapular–axillary block group. Total analgesic consumption during the first 24 hours was similar between both groups. Respiratory discomfort and transient diaphragmatic paresis was seen 58% in the interscalene block. Suprascapular–axillary block technique shows less respiratory-related complications.
Conclusion: Effectiveness in providing postoperative analgesia after arthroscopy of the shoulder contributes evidence that both suprascapular nerve block with axillary nerve block 186 and interscalene brachial plexus block 187 are suitable techniques. Although the interscalene block provides marginally better early postoperative analgesia than block of suprascapular and axillary nerves, the latter provides comparable total analgesia with fewer respiratory complications.
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