Anterior suprascapular nerve block versus interscalene brachial plexus block for arthroscopic shoulder surgery: a systematic review and meta-analysis of randomized controlled trials.

Published on Sep 17, 2021in Journal of Anesthesia2.078
· DOI :10.1007/S00540-021-03000-Z
Leigh White12
Estimated H-index: 12
,
Damon Reardon + 2 AuthorsMatthew Bright (Princess Alexandra Hospital)
Sources
Abstract
This systematic review aimed to compare the analgesic effectiveness and complications rates for anterior suprascapular nerve blocks (ASSB) compared to interscalene brachial plexus blocks (ISB) for arthroscopic and outpatient shoulder surgery. Only randomized controlled trials (RCTs) comparing the ASSB versus ISB in the context of arthroscopic shoulder surgery were eligible for inclusion. The primary outcomes included pain scores (Numeric Rating Scale of 0 to 10) up to 24 h postoperatively and analgesic consumption. Secondary outcomes included block complications. Meta-analysis was performed using random-effects modeling and result certainty was determined using the GRADEpro tool. Six RCTs (709 patients) were included for analysis. ISB displayed a statistically significant reduction in pain scores by 0.40 (95%CI = 0.36 to 0.45; p < 0.00001) but not morphine equivalent consumption (mean difference = 0.74 mg; 95%CI = − 0.18 to 1.66 mg; I2 = 60%; p = 0.11; moderate certainty) immediately in the postoperative care unit. Opioid consumption and pain scores at 6 to 24 h were not significantly different. There was no difference in respiratory events postblock. ASSB demonstrated a significantly lower incidence of Horner’s syndrome (relative risk (RR) = 0.17; 95%CI = 0.08 to 0.39; p < 0.00001; high certainty), voice hoarseness (RR = 0.24; 95%CI = 0.10 to 0.57; p < 0.00001; high certainty) and impaired respiratory function (p < 0.00001). The ASSB could be considered an appropriate analgesic option for arthroscopic shoulder surgery with potentially fewer complications than the ISB.
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References33
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#1David PetroffH-Index: 26
#2Martin WiegelH-Index: 4
Last. Andreas W. ReskeH-Index: 14
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BACKGROUND Ultrasound-guided interscalene brachial plexus block (ISB) is used to control pain after shoulder surgery. Though effective, drawbacks include phrenic nerve block and motor block of the hand. The ultrasound-guided anterior approach to perform suprascapular nerve block (SSNB) may provide a good alternative. OBJECTIVE To compare lung ventilation and diaphragmatic activity on the operated side in ISB and SSNB. DESIGN Randomised, controlled patient-blinded and assessor-blinded trial. SETT...
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#1Yean Chin Lim (CGH: Changi General Hospital)H-Index: 1
#2Zhao Kun Koo (CGH: Changi General Hospital)H-Index: 1
Last. Qian Jun Tong (CGH: Changi General Hospital)H-Index: 2
view all 6 authors...
Background Interscalene brachial plexus block (ISB) provides excellent analgesia for arthroscopic shoulder surgeries but is associated with adverse effects including hemidiaphragmatic paresis from phrenic nerve blockade. The primary aim is to compare the respiratory effects, forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), of suprascapular nerve block (SSB) with ISB. Methods Sixty patients were recruited after taking informed consent and randomized into 3 groups, ISB,...
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#1P. Rhyner (UNIL: University of Lausanne)H-Index: 1
#2Kyle R. Kirkham (U of T: University of Toronto)H-Index: 20
Last. Eric Albrecht (UNIL: University of Lausanne)H-Index: 23
view all 5 authors...
The shoulder block may impair ventilatory function and diaphragmatic movement less than the interscalene brachial plexus block. We randomly allocated 30 adults who underwent shoulder arthroscopy under general anaesthesia to ultrasound-guided shoulder block or interscalene block with 20 ml bupivacaine 0.5%. The primary outcome, rate of ultrasound-measured hemidiaphragmatic excursion < 25% of baseline 30 min after blockade, was reduced from 12/15 with brachial plexus block to 2/15 with shoulder bl...
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#1Faraj W. AbdallahH-Index: 29
Last. Vincent W. S. ChanH-Index: 59
view all 8 authors...
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 th...
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#1Fabrice Ferré (University of Toulouse)H-Index: 12
#2M. Pommier (University of Toulouse)H-Index: 1
Last. Vincent Minville (University of Toulouse)H-Index: 28
view all 9 authors...
Interscalene brachial plexus block provides analgesia for shoulder surgery but is associated with hemidiaphragmatic paralysis. Before considering a combined suprascapular and axillary nerve block as an alternative to interscalene brachial plexus block, evaluation of the incidence of diaphragmatic dysfunction according to the approach to the suprascapular nerve is necessary. We randomly allocated 84 patients undergoing arthroscopic shoulder surgery to an anterior or a posterior approach to the su...
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#1Gavin Hamilton (Ottawa Hospital Research Institute)H-Index: 50
#2Reva RamloganH-Index: 5
Last. Daniel I. McIsaacH-Index: 23
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Background:Nerve blocks improve early pain after ambulatory shoulder surgery; impact on postdischarge outcomes is poorly described. Our objective was to measure the association between nerve blocks and health system outcomes after ambulatory shoulder surgery.Methods:We conducted a population-based c
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PURPOSE OF REVIEW: Day surgery coming and leaving hospital day of surgery is growing. From minor and intermediate procedure performed on health patient, day surgery is today performed on complex procedures and elderly patient and on patients with comorbidities. Thus, appropriate discharge assessment is of huge importance to secure safety and quality of care. RECENT FINDINGS: Discharge has since decades been assessed on a combination of stable vital signs, control of pain and postoperative nausea...
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#1O. Toma (UEA: University of East Anglia)H-Index: 1
#2B. Persoons (Katholieke Universiteit Leuven)H-Index: 1
Last. Girish P. Joshi (UTSW: University of Texas Southwestern Medical Center)H-Index: 51
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Rotator cuff repair can be associated with significant and difficult to treat postoperative pain. We aimed to evaluate the available literature and develop recommendations for optimal pain management after rotator cuff repair. A systematic review using procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in English from 1 January 2006 to 15 April 2019 assessing postoperative pain after rotator cuff repair using analgesic, ...
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#1David B. Auyong (Virginia Mason Medical Center)H-Index: 15
#2Neil A. HansonH-Index: 13
Last. Stanley C. YuanH-Index: 4
view all 6 authors...
BACKGROUND:The interscalene nerve block provides analgesia for shoulder surgery, but is associated with diaphragm paralysis. One solution may be performing brachial plexus blocks more distally. This noninferiority study evaluated analgesia for blocks at the supraclavicular and anterior suprascapular levels, comparing them individually to the interscalene approach. METHODS:One hundred-eighty-nine subjects undergoing arthroscopic shoulder surgery were recruited to this double-blind trial and rando...
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#1Nasir Hussain (CMU: Central Michigan University)H-Index: 17
#2Ghazaleh Goldar (McMaster University)H-Index: 1
Last. Faraj W. Abdallah (Ottawa Hospital Research Institute)H-Index: 29
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Background:Interscalene block provides optimal shoulder surgery analgesia, but concerns over its associated risks have prompted the search for alternatives. Suprascapular block was recently proposed as an interscalene block alternative, but evidence of its comparative analgesic effect is conflicting
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