Suprascapular and Interscalene Nerve Block as Analgesia After Arthroscopic Rotator Cuff Repair: a Retrospective Comparative Cohort Study
Article Sidebar
Published:
Aug 17, 2023
Keywords:
Rotator cuff tear, interscalene block, suprascapular nerve block, arthroscopic repair
Main Article Content
Abstract
Introduction: This study aimed to compare the efficacy of interscalene block (ISB) and suprascapular nerve block (SSNB), individually and in combination (ISB+SSNB), used as postoperative analgesia within the first 3 hours after arthroscopic rotator cuff repair.
Materials and Methods: Retrospective comparative cohort study, conducted between 2019 and 2021. The primary endpoint was shoulder pain score in the immediate postoperative period as reported on a visual analog scale (VAS) by the patient. Secondary endpoints were opioid use in the recovery room (first 3 hours) and locoregional anesthesia complications.
Results: 175 patients were included; 13 in the ISB group, 61 in the ISB+SSNB group, and 101 in the SSNB group. The ISB group and the ISB+SSNB group had significantly less pain in the recovery room than the SSNB group (p = 0.001 and p < 0.001, respectively). The percentage of patients who required at least one dose of opioid and the total number of opioids consumed in milligrams of morphine equivalent were significantly lower for the ISB and ISB+SSNB groups than for the SSNB group (p < 0.001). There were no significant differences in pain or opioid use between ISB alone or combined with SSNB (ISB+SSNB).
Conclusions: In this retrospective comparative study, ISB was more effective in relieving pain and reducing opioid use in the recovery room after arthroscopic rotator cuff repair than SSNB. The ISB+SSNB combination did not increase effectiveness, and therefore it is suggested not to combine these two techniques.
Materials and Methods: Retrospective comparative cohort study, conducted between 2019 and 2021. The primary endpoint was shoulder pain score in the immediate postoperative period as reported on a visual analog scale (VAS) by the patient. Secondary endpoints were opioid use in the recovery room (first 3 hours) and locoregional anesthesia complications.
Results: 175 patients were included; 13 in the ISB group, 61 in the ISB+SSNB group, and 101 in the SSNB group. The ISB group and the ISB+SSNB group had significantly less pain in the recovery room than the SSNB group (p = 0.001 and p < 0.001, respectively). The percentage of patients who required at least one dose of opioid and the total number of opioids consumed in milligrams of morphine equivalent were significantly lower for the ISB and ISB+SSNB groups than for the SSNB group (p < 0.001). There were no significant differences in pain or opioid use between ISB alone or combined with SSNB (ISB+SSNB).
Conclusions: In this retrospective comparative study, ISB was more effective in relieving pain and reducing opioid use in the recovery room after arthroscopic rotator cuff repair than SSNB. The ISB+SSNB combination did not increase effectiveness, and therefore it is suggested not to combine these two techniques.
Downloads
Download data is not yet available.
Metrics
Metrics Loading ...
Article Details
How to Cite
Rojas Lievano, J., Salas, M., Salas, C., Suarez, A. M., Fierro, G., & González, J. C. (2023). Suprascapular and Interscalene Nerve Block as Analgesia After Arthroscopic Rotator Cuff Repair: a Retrospective Comparative Cohort Study. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(4), 379-385. https://doi.org/10.15417/issn.1852-7434.2023.88.4.1594
Section
Clinical Research
Copyright (c) 2023 Revista de la Asociación Argentina de Ortopedia y Traumatología
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
References
1. Suárez LJM, Fierro G, González GJC. Dolor postoperatorio en cirugía de reparación del manguito rotador mini
abierto y artroscópico bajo protocolo de analgesia multimodal. Rev Colomb Ortop Traumatol 2020;34(2):144-50.
https://doi.org/10.1016/j.rccot.2020.06.015
2. Uquillas CA, Capogna BM, Rossy WH, Mahure SA, Rokito AS. Postoperative pain control after arthroscopic
rotator cuff repair. J Shoulder Elbow Surg 2016;25(7):1204-13. https://doi.org/10.1016/j.jse.2016.01.026
3. Kay J, Memon M, Hu T, Simunovic N, Duong A, Paul J, et al. Suprascapular nerve blockade for postoperative
pain control after arthroscopic shoulder surgery: A systematic review and meta-analysis. Orthop J Sport Med
2018;6(12):1-17. https://doi.org/10.1177/2325967118815859
4. Pizzi LT, Toner R, Foley K, Thomson E, Chow W, Kim M, et al. Relationship between potential opioid-related
adverse effects and hospital length of stay in patients receiving opioids after orthopedic surgery. Pharmacotherapy 2012;32(6):502-14. https://doi.org/10.1002/j.1875-9114.2012.01101.x
5. Kim H, Kim HJ, Lee ES, Lee S, Park JH, Kim H, et al. Postoperative pain control after arthroscopic rotator cuff
repair: Arthroscopy-guided continuous suprascapular nerve block versus ultrasound-guided continuous interscalene block. Arthroscopy 2021;37(11):3229-37. https://doi.org/10.1016/j.arthro.2021.04.067
6. Sun C, Zhang X, Ji X, Yu P, Cai X, Yang H. Suprascapular nerve block and axillary nerve block versus interscalene
nerve block for arthroscopic shoulder surgery: A meta-analysis of randomized controlled trials. Medicine
(Baltimore) 2021;100(44):e27661. https://doi.org/10.1097/MD.0000000000027661.7
7. Salviz EA, Xu D, Frulla A, Kwofie K, Shastri U, Chen J, et al. Continuous interscalene block in patients having
outpatient rotator cuff repair surgery: A prospective randomized trial. Anesth Analg 2013;117(6):1485-92.
https://doi.org/10.1213/01.ane.0000436607.40643.0a
8. Desroches A, Klouche S, Schlur C, Bauer T, Waitzenegger T, Hardy P. Suprascapular nerve block versus
interscalene block as analgesia after arthroscopic rotator cuff repair: A randomized controlled noninferiority trial. Arthroscopy 2016;32(11):2203-9. https://doi.org/10.1016/j.arthro.2016.03.013
9. Kim JH, Koh HJ, Kim DK, Lee HJ, Kwon KH, Lee KY, et al. Interscalene brachial plexus bolus block versus
patient-controlled interscalene indwelling catheter analgesia for the first 48 hours after arthroscopic rotator cuff
repair. J Shoulder Elbow Surg 2018;27(7):1243-50. https://doi.org/10.1016/j.jse.2018.02.048
10. Kim YS, Lee HJ, Park I, Im JH, Park KS, Lee SB. Are delayed operations effective for patients with rotator cuff
tears and concomitant stiffness? An analysis of immediate versus delayed surgery on outcomes. Arthroscopy
2015;31(2):197-204. https://doi.org/10.1016/j.arthro.2014.08.014
11. Koga R, Funakoshi T, Yamamoto Y, Kusano H. Suprascapular nerve block versus interscalene block for analgesia after arthroscopic rotator cuff repair. J Orthop 2019;19:28-30. https://doi.org/10.1016/j.jor.2019.11.013
abierto y artroscópico bajo protocolo de analgesia multimodal. Rev Colomb Ortop Traumatol 2020;34(2):144-50.
https://doi.org/10.1016/j.rccot.2020.06.015
2. Uquillas CA, Capogna BM, Rossy WH, Mahure SA, Rokito AS. Postoperative pain control after arthroscopic
rotator cuff repair. J Shoulder Elbow Surg 2016;25(7):1204-13. https://doi.org/10.1016/j.jse.2016.01.026
3. Kay J, Memon M, Hu T, Simunovic N, Duong A, Paul J, et al. Suprascapular nerve blockade for postoperative
pain control after arthroscopic shoulder surgery: A systematic review and meta-analysis. Orthop J Sport Med
2018;6(12):1-17. https://doi.org/10.1177/2325967118815859
4. Pizzi LT, Toner R, Foley K, Thomson E, Chow W, Kim M, et al. Relationship between potential opioid-related
adverse effects and hospital length of stay in patients receiving opioids after orthopedic surgery. Pharmacotherapy 2012;32(6):502-14. https://doi.org/10.1002/j.1875-9114.2012.01101.x
5. Kim H, Kim HJ, Lee ES, Lee S, Park JH, Kim H, et al. Postoperative pain control after arthroscopic rotator cuff
repair: Arthroscopy-guided continuous suprascapular nerve block versus ultrasound-guided continuous interscalene block. Arthroscopy 2021;37(11):3229-37. https://doi.org/10.1016/j.arthro.2021.04.067
6. Sun C, Zhang X, Ji X, Yu P, Cai X, Yang H. Suprascapular nerve block and axillary nerve block versus interscalene
nerve block for arthroscopic shoulder surgery: A meta-analysis of randomized controlled trials. Medicine
(Baltimore) 2021;100(44):e27661. https://doi.org/10.1097/MD.0000000000027661.7
7. Salviz EA, Xu D, Frulla A, Kwofie K, Shastri U, Chen J, et al. Continuous interscalene block in patients having
outpatient rotator cuff repair surgery: A prospective randomized trial. Anesth Analg 2013;117(6):1485-92.
https://doi.org/10.1213/01.ane.0000436607.40643.0a
8. Desroches A, Klouche S, Schlur C, Bauer T, Waitzenegger T, Hardy P. Suprascapular nerve block versus
interscalene block as analgesia after arthroscopic rotator cuff repair: A randomized controlled noninferiority trial. Arthroscopy 2016;32(11):2203-9. https://doi.org/10.1016/j.arthro.2016.03.013
9. Kim JH, Koh HJ, Kim DK, Lee HJ, Kwon KH, Lee KY, et al. Interscalene brachial plexus bolus block versus
patient-controlled interscalene indwelling catheter analgesia for the first 48 hours after arthroscopic rotator cuff
repair. J Shoulder Elbow Surg 2018;27(7):1243-50. https://doi.org/10.1016/j.jse.2018.02.048
10. Kim YS, Lee HJ, Park I, Im JH, Park KS, Lee SB. Are delayed operations effective for patients with rotator cuff
tears and concomitant stiffness? An analysis of immediate versus delayed surgery on outcomes. Arthroscopy
2015;31(2):197-204. https://doi.org/10.1016/j.arthro.2014.08.014
11. Koga R, Funakoshi T, Yamamoto Y, Kusano H. Suprascapular nerve block versus interscalene block for analgesia after arthroscopic rotator cuff repair. J Orthop 2019;19:28-30. https://doi.org/10.1016/j.jor.2019.11.013