Selective Suprascapular and Axillary Nerve Block Versus Interscalene Plexus Block for Pain Control After Arthroscopic Shoulder Surgery: A Noninferiority Randomized Parallel-Controlled Clinical Trial

Background and Objectives This randomized trial aimed to assess if a combined suprascapular-axillary nerve block (SSB) is noninferior (margin = 1.3 on a 0- to 10-point scale) to interscalene block (ISB) in treating pain after arthroscopic shoulder surgery. Secondary end points included opioid consumption, dyspnea, discomfort associated with muscle weakness, and patient satisfaction. Methods One hundred patients undergoing arthroscopic shoulder surgery were randomized to receive ultrasound-guided ISB (n = 50) or SSB (n = 50). Pain intensity at rest, dyspnea, and discomfort were recorded upon arrival in the recovery room, discharge to the ward, and at 4, 8, and 24 hours after surgery. Piritramide consumption was recorded for the first 24 hours. Patient satisfaction was assessed on the second postoperative day. Results During the first 4 hours after surgery, the difference in mean pain score between SSB and ISB was higher than 2.5 (±0.8). The difference gradually decreased to 1.1 (±1.0) at 8 hours before resulting in noninferiority during the night and at 24 hours. Piritramide consumption was significantly higher in the SSB group in the first 8 hours. The incidence of dyspnea and discomfort was higher after ISB. Treatment satisfaction was similar in both groups. Conclusions Suprascapular-axillary nerve block is inferior to ISB in terms of analgesia and opioid requirement in the immediate period after arthroscopic shoulder surgery but is associated with a lower incidence of dyspnea and discomfort. The difference in pain and opioid consumption gradually decreases as the blocks wear off in order to reach similar pain scores during the first postoperative night and at 24 hours. Clinical Trial Registration This study was registered at ClinicalTrials.gov, identifier NCT02415088. Accepted for publication December 30, 2017. Address correspondence to: Björn Stessel, MD, PhD, Department of Anesthesiology and Pain Treatment, Jessa Hospital, Virga-Jesse Campus, Stadsomvaart 11, 3500 Hasselt, Belgium (e-mail: bjornstessel@hotmail.com). This study is part of the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, Province of Limburg, Flemish Government, Hasselt University, Ziekenhuis Oost-Limburg, and Jessa Hospital. The authors declare no conflict of interest. Authors' contributions: A.N. was responsible for the study design, data collection, and writing of the paper. B.S. was responsible for the study design, data interpretation, table creation, and writing of the paper. P.F.W. was responsible for the data interpretation and writing of the paper. C.D. was responsible for the study design and the writing of the paper. W.C. provided statistical expertise and was responsible for the statistical analyses and figure creation. J.-P.O., I.A., L.J., and J.D. were responsible for the writing of the paper. D.S. conceived of the study and was responsible for the study design, the literature search, execution of all regional blocks, and writing of the paper. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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