Shoulder block versus interscalene block for postoperative pain relief after shoulder arthroscopy

Hala E Zanfaly, Amani A Aly

Ain-Shams Journal of Anaesthesiology 2016 9(2):296-303

Background Adequate pain control allows early rehabilitation and improves outcome after shoulder arthroscopic procedures. Objective The aim of this study was to compare the interscalene nerve block (ISB) with shoulder block (ShB) (suprascapular and axillary nerve blocks) for postoperative pain relief after arthroscopic shoulder surgery. Design This was a prospective, randomized, comparative study. Patients and methods A total of 75 patients of ASA grade I or II scheduled for shoulder arthroscopic surgery were equally divided into three groups (25 patients each): the general anesthesia (GA)-only group; the GA with ISB group; and the GA with ShB group. The nerve block was guided by both ultrasound and nerve stimulator. Visual analogue scale score was evaluated at the recovery room and 2, 4, 8, 16, and 24 h postoperatively. The time to first call for analgesia, total analgesic requirement for 24 h postoperatively, patient satisfaction, and any complications were recorded. Results The visual analogue scale score was significantly less in the GA + ISB and GA + ShB groups compared with the GA-only group (P < 0.001). The time to first analgesic request was significantly longer in the GA + ISB group [10 (9-10 h)] and GA + ShB group [9 (9-10 h)] compared with the GA-only group [1 (1 h)] (P < 0.001). The total dose of morphine consumption was significantly higher in the GA-only group [10 (9-10 mg)] compared with the GA + ISB group [6 (5-6 mg)] and the GA + ShB group [6 (6-7 mg)] (P < 0.001). Patient satisfaction was significantly higher in the GA + ISB group [9 (9-10)] and in the GA + ShB group [8 (8-9)] compared with the GA-only group [1 (1-2)] (P < 0.001). The incidence of complications was significantly higher in the GA + ISB group compared with the other two groups (P < 0.001). Conclusion ShB was as effective as ISB for postoperative pain relief but with fewer complications. Thus, ShB is a good alternative for patients at high risk for adverse events with ISB.

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