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Saxena P, Singh MK, Chaurasia MK, Singh S. Efficacy of Infraclavicular Brachial Plexus Block Alone Versus Combination With Suprascapular Nerve Block in Patients Undergoing Shoulder Surgeries: A Single-Blind, Randomized Trial. Cureus 2024; 16:e52961. [PMID: 38406148 PMCID: PMC10894077 DOI: 10.7759/cureus.52961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Background and aim The regional anesthesia technique is commonly used for upper extremity surgery as an alternative to general anesthesia. The study aimed to compare the efficacy of infraclavicular brachial plexus block (BPB) and a combination of infraclavicular brachial plexus block with suprascapular nerve block for postoperative analgesia in patients undergoing shoulder surgeries. Method A total of 62 patients of both sexes with the American Society of Anaesthesiologists (ASA) physical status I/II/III, aged between 18 and 65 years, and undergoing shoulder surgery, were included in this prospective, single-blinded, randomized controlled trial. Patients were equally allocated into two groups: 31 in group A and 31 in group B. After pre-anesthetic evaluation, the purpose and protocol of the study were explained to patients, and informed consent was obtained. Thirty-one patients in group A were given infraclavicular brachial plexus block using 30 ml 0.375% bupivacaine while 31 patients in group B were given a combination of infraclavicular brachial plexus block using 30 ml 0.375% bupivacaine and suprascapular nerve block using 5 ml 0.375% bupivacaine. Blocks were given using ultrasound guidance and a peripheral nerve stimulator; the suprascapular block was given in the sitting position while the infraclavicular block was provided in the supine position. General anesthesia was administered in the operation theatre in the supine position after the administration of blocks. The pain was assessed using the visual analog scale (VAS) and the satisfaction score was assessed by the numeric rating scale (NRS). The Mann-Whitney U test was applied for comparison of pain between the two groups. The chi-square test was utilized for comparing the categorical variables. Result The postoperative pain was significantly lower (p<0.001) in group B as compared to group A at all the periods of observation, i.e., 0h (2.77±0.72 vs. 5.42±0.77), 6h (3.89±0.70 vs. 5.94±0.73), 12h (5.66±0.93 vs. 6.58±0.88), and 24h (6.16±0.80 vs. 6.74±0.90). These findings illustrate that group B patients who received a combination of infraclavicular brachial plexus block and suprascapular nerve block for shoulder surgeries had better pain relief than group A patients who received only the infraclavicular approach. The mean NRS score of patient satisfaction in group B (7.26±0.58) was significantly higher (p<0.001) in comparison to group A (6.16±0.64). Diaphragmatic palsy was observed in only one case in group A and none in group B. No other complication was observed in any of the patients during the study period. Conclusion The combination of infraclavicular brachial plexus block and suprascapular nerve block displays a positive postoperative analgesic profile with less usage of rescue analgesic doses and better patient satisfaction after shoulder surgery.
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Affiliation(s)
- Parul Saxena
- Department of Anesthesiology, King George's Medical University, Lucknow, IND
| | - Manish K Singh
- Department of Anesthesiology, King George's Medical University, Lucknow, IND
| | - Manoj K Chaurasia
- Department of Anesthesiology, King George's Medical University, Lucknow, IND
| | - Sarita Singh
- Department of Anesthesiology, King George's Medical University, Lucknow, IND
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Filkin J, Massy-Westropp N, Wechalekar H. Variability in the distance between the suprascapular notch with the spine of the scapulae and the acromion. Clin Rheumatol 2024; 43:527-532. [PMID: 37935986 PMCID: PMC10774181 DOI: 10.1007/s10067-023-06807-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/16/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION The suprascapular notch lies in the superior border of the scapula and is a passageway for the suprascapular nerve that is sensory to the shoulder joint. Suprascapular nerve block involves injection of local anaesthetic into the suprascapular notch, either ultrasound guided or blind, using the spine of scapula and/or the medial border of the acromion as surface landmarks. AIM To investigate the anatomic variations that exist between the distance of the notch from the spine of scapula and acromion. METHOD Ninety-two dry scapulae were measured with a digital calliper for their length of the spine, distance between the midpoint of the spine and base of the suprascapular notch and distance between the medial border of the acromion and the base of the suprascapular notch. These measurements were compared for variations in the scapular bony landmarks, the spine and the acromion to determine the site for the injection. RESULTS Measurement reliability was assessed by intraclass correlation, Cronbach's alpha being 0.99, 0.97 and 0.91 for length of spine, distance from spine and distance from acromion respectively. The distance from the acromion had less variation in measurement (3.73 ± 0.42 cm) but a flatter distribution when compared to distance from the spine of the scapula (3.32 ± 0.39 cm). CONCLUSION Length of the spine of the scapula appeared not to influence either distance from the acromion or distance from the spine of scapula. There is potential for greater variability in placement of nerve blocks that use acromion as the bony reference. Key Points • Dry scapular measurement using electronic Vernier callipers is accurate (0.91-0.97). • There is potential for greater variability in placement of blind nerve blocks that use acromion as the bony reference to locate the suprascapular notch.
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Affiliation(s)
- Jesse Filkin
- Undergraduate Bachelor of Medical Radiation Science (Nuclear Medicine), University of South Australia, City East Campus, Adelaide, Australia
| | - Nicola Massy-Westropp
- UniSA Allied Health and Human Performance, University of South Australia, City East Campus, Level 8 Centenary Building, North Terrace, 5000, Australia.
| | - Harsha Wechalekar
- UniSA: Allied Health and Human Performance, University of South Australia, North Terrace 5000, City East Campus, Adelaide, Australia
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Boekel P, Brereton SG, Doma K, Grant A, Kippin A, Wilkinson M, Morse L. Efficacy of surgeon-directed suprascapular and axillary nerve blocks in shoulder arthroscopy: a 3-arm prospective randomized controlled trial. JSES Int 2023; 7:307-315. [PMID: 36911772 PMCID: PMC9998877 DOI: 10.1016/j.jseint.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The use of regional anesthesia in shoulder arthroscopy improves perioperative pain control, thereby reducing the need for opioids and their recognized side effects. Occasionally one type of block is not suitable for a patient's anatomy or comorbidities or requires a specially trained anesthetist to safely perform. The primary aim of this study is to compare the efficacy of 3 different nerve blocks for pain management in patients undergoing shoulder arthroscopy. Methods A 3-arm, blinded, randomized controlled trial in patients undergoing elective, unilateral shoulder arthroscopic procedures between August 2018 and November 2020 was conducted at a single center. One hundred and thirty participants were randomized into 1 of 3 regional anesthesia techniques. The first group received an ultrasound-guided interscalene block performed by an anesthetist (US + ISB). The second group received an ultrasound-guided suprascapular nerve block and an axillary nerve block by an anesthetist (US + SSANB). The final group received a suprascapular nerve block without ultrasound and an axillary nerve block under arthroscopic guidance by an orthopedic surgeon (A + SSANB). Intraoperative pain response, analgesia requirements, and side effects were recorded. Visual analogue pain scores and opioid doses were recorded in the Post Anaesthesia Care Unit (PACU) and daily for 8 days following the procedure. Results Twelve patients withdrew from the study after randomization, leaving 39 participants in US + ISB, 40 in US + SSANB, and 39 in A + SSANB. The US + ISB group required significantly lower intraoperative opioid doses than US + SSANB and A + SSANB (P < .001) and postoperatively in PACU (P < .001). After discharge from hospital, there were no differences between all groups in daily analgesia requirements (P = .063). There was significantly more nerve complications with 6 patient-reported complications in the US + ISB group (P = .02). There were no reported differences in satisfaction rates between groups (P = .41); however, the A + SSANB group was more likely to report a wish to not have a regional anesthetic again (P = .04). Conclusion The US + ISB group required lower opioid doses perioperatively; however, there was no difference between groups after discharge from PACU. The analgesia requirements between the US + SSANB and A + SSANB were similar intraoperatively and postoperatively. A surgeon-administered SSANB may be a viable alternative when an experienced regional anesthetist is not available.
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Affiliation(s)
- Pamela Boekel
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia
- Mater Health Services North Queensland, Pimlico, Townsville, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook, University, Townsville, Queensland, Australia
- Corresponding author: Pamela Boekel, MBBS (Hons), MSc, FRACS (Orth), Orthopaedic Research Institute of Queensland, 7 Turner St, Pimlico, Queensland, Australia 4812.
| | - Sarah G. Brereton
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia
- Mater Health Services North Queensland, Pimlico, Townsville, Queensland, Australia
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Kenji Doma
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia
- Department of Sports and Exercise Science, James Cook University, Townsville, Queensland, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia
| | - Alex Kippin
- Mater Health Services North Queensland, Pimlico, Townsville, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook, University, Townsville, Queensland, Australia
| | - Matthew Wilkinson
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia
- Department of Orthopaedic Surgery, Royal Hobart Hospital and Calvary Care, University of Tasmania, Hobart, Tasmania, Australia
| | - Levi Morse
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia
- Mater Health Services North Queensland, Pimlico, Townsville, Queensland, Australia
- Department of Orthopaedic Surgery, Townsville University Hospital, James Cook, University, Townsville, Queensland, Australia
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Saravanan R, Nivedita K, Karthik K. Selective Suprascapular and Axillary nerve (SSAX) block – A diaphragm sparing regional anesthetic technique for shoulder surgeries: A case series. Saudi J Anaesth 2022; 16:457-459. [PMID: 36337404 PMCID: PMC9630674 DOI: 10.4103/sja.sja_782_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 12/05/2022] Open
Abstract
Interscalene block, the gold standard for shoulder surgeries is inevitably associated with phrenic nerve palsy, even at low volumes. The major innervation of the shoulder joint is by suprascapular nerve and axillary nerve. Suprascapular nerve block has been used commonly for postoperative analgesia in shoulder surgeries done under GA. Combining axillary block with suprascapular nerve block was found to provide superior analgesia when compared to suprascapular block alone. Selective Suprascapular and Axillary nerve (SSAX) block provides effective analgesia in shoulder surgeries without causing diaphragm palsy, but has limited published literature. We performed ultrasound guided suprascapular block in the supraspinous fossa (posterior approach) using 10 ml of 0.25% Ropivacaine and axillary block in the quadrangular space using 6ml of 0.25% Ropivacaine before administration of general anaesthesia (GA) in 4 cases. Among four cases, 2 were closed shoulder manipulation with intra-articular steroid injection for periarthritis, 1 was closed reduction and K-wire fixation for chronic shoulder subluxation and the 4th was Latarjet procedure for recurrent shoulder dislocation. All patients received paracetamol 1g at the end of the procedure and every 6 h postoperatively. No patient experienced pain during recovery and the analgesia lasted for a mean duration of 347.5 minutes. Tramadol was required for rescue analgesia in only one patient (Latarjet surgery). We found that SSAX block provided effective analgesia in all patients, but needs randomized controlled trials with larger sample size comparing with interscalene block.
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Miyatake K, Fujisawa T, Otoshi A, Kawabata Y, Kusaba Y, Tsujiku S, Inaba Y. Silent Manipulation for Adhesive Capsulitis. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00332-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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:e27661. [PMID: 34871240 PMCID: PMC8568401 DOI: 10.1097/md.0000000000027661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/14/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The interscalene brachial plexus block (ISB) is a commonly used nerve block technique for postoperative analgesia in patients undergoing shoulder arthroscopy surgery; however, it is associated with potentially serious complications. The use of suprascapular nerve block (SSNB) and axillary Nerve Block (ANB) has been reported as an alternative nerve block with fewer reported side effects for shoulder arthroscopy. This review aimed to compare the impact of SSNB and ANB with ISB during shoulder arthroscopy surgery. METHODS A meta-analysis was conducted to identify relevant randomized or quasirandomized controlled trials involving SSNB and ISB during shoulder arthroscopy surgery. We searched Web of Science, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CNKI, and Wanfang database from 2010 through August 2021. RESULTS We identified 641 patients assessed in 10 randomized or quasirandomized controlled trials. Compared with the ISB group, the SSNB+ANB group had higher visual analog scale or numerical rating scale in PACU (P = .03), 4 hour (P = .001),6 hour after the operation (P = .002), and lower incidence of complications such as Numb/Tingling (P = .001), Weakness (P <.00001), Horner syndrome (P = .001) and Subjective dyspnea (P = .002). No significant difference was found for visual analog scale or numerical rating scale 8 hour (P = .71),12 hour (P = .17), 16 hour (P = .38),1day after operation (P = .11), patient satisfaction (P = .38) and incidence of complications such as hoarseness (P = .07) and nausea/vomiting (P = .41) between 2 groups. CONCLUSION Our high-level evidence has established SSNB+ ANB as an effective and safe analgesic technique and a clinically attractive alternative to interscalene block during arthroscopic shoulder surgery, especially for severe chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity. Given our meta-analysis's relevant possible biases, we required more adequately powered and better-designed randomized controlled trial studies with long-term follow-up to reach a firmer conclusion.
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Affiliation(s)
- Changjiao Sun
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, China
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine,Tsinghua University, No.168 Litang Road, Dongxiaokou Town,Changping District, Beijing, China
| | - Xiaolin Ji
- Department of Anesthesia, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Institutional address: No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, China
| | - Peng Yu
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, China
| | - Xu Cai
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, China
| | - Huadong Yang
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, China
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Zhao J, Xu N, Li J, Liang G, Zeng L, Luo M, Pan J, Yang W, Liu J. Efficacy and safety of suprascapular nerve block combined with axillary nerve block for arthroscopic shoulder surgery: A systematic review and meta-analysis of randomized controlled trials. Int J Surg 2021; 94:106111. [PMID: 34520842 DOI: 10.1016/j.ijsu.2021.106111] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/20/2021] [Accepted: 09/10/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS A variety of peripheral nerve block methods are used in the clinic to enhance the effect of postoperative analgesia. In recent years, an increasing number of surgeons have considered the efficacy and safety of suprascapular nerve block (SSNB) combined with axillary nerve block (ANB) for controlling perioperative pain in shoulder arthroscopy. The purpose of this study was to compare the efficacy and safety of SSNB + ANB and interscalene block (ISB) versus SSNB alone for shoulder arthroscopic surgery. STUDY DESIGN Systematic review; Level of evidence, 1. METHODS The protocol for this meta-analysis is registered with PROSPERO (CRD42021254008). PubMed, Cochrane Library, Embase and CNKI were searched for RCTs from inception to April 30, 2021. A meta-analysis was performed with Review Manager 5.3 to calculate the RR or WMD of related outcome indicators. RESULTS Nine RCTs involving 543 cases from 5 countries were included. Compared with SSNB alone, SSNB + ANB was more effective at pain relief at 6, 12, 24, 36 and 48 h postoperatively. In terms of patient satisfaction score, scores for SSNB + ANB at 12 (WMD = 2.01, 95% CI = 0.25 to 3.78) and 24 (WMD = 1.68, 95% CI = 0.11 to 3.24) hours after the operation were higher than those of SSNB alone, but there was no significant difference at 36 and 48 h postsurgery. There was no significant difference in pain score between SSNB + ANB and ISB at 6 and 12 h after surgery or in patient satisfaction at 24 h (WMD = 0.13, 95% CI = -0.36 to 0.63) postsurgery between SSNB + ANB and ISB. In terms of safety, compared with ISB, SSNB + ANB reduced the incidence of dyspnea (RR = 0.25, 95% CI = 0.09 to 0.68). CONCLUSIONS Compared with SSNB alone, SSNB + ANB has better advantages regarding pain relief and patient satisfaction within 24 h after surgery. Compared with ISB, SSNB + ANB shows no difference in postoperative pain relief or patient satisfaction, but SSNB + ANB can reduce the incidence of dyspnea more than ISB.
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Affiliation(s)
- Jinlong Zhao
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Academy of Traditional Chinese Medicine, Guangzhou, 510120, China The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guagnzhou, 510405, China Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, 510095, China The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China The Department of Sports Medicine of the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, 510120, China
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Saini S, Rao SM, Agrawal N, Gupta A. Comparison of analgesic efficacy of shoulder block versus interscalene block for postoperative analgesia in arthroscopic shoulder surgeries: A randomised trial. Indian J Anaesth 2021; 65:451-457. [PMID: 34248188 PMCID: PMC8253006 DOI: 10.4103/ija.ija_110_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/04/2021] [Accepted: 05/22/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Arthroscopic orthopaedic surgery may lead to significant postoperative pain. Interscalene block (ISB) is associated with undesirable effects like phrenic nerve palsy. Shoulder block (ShB) is a relatively recent diaphragm sparing alternative for analgesia in these cases. Methods This prospective randomised trial was conducted in 70 adult patients posted for arthroscopic Bankart repair surgery. Patients were randomly assigned into two groups: interscalene block [Group ISB (n = 35): 0.5% bupivacaine 10 ml] or shoulder block [Group ShB (n = 35): 0.5% bupivacaine (suprascapular block 10 ml and axillary block 10 ml)] using ultrasound and nerve stimulator. The primary aim of our study was to compare the ISB with ShB for visual analogue score (VAS) in recovery area (zero hour). Time for block performance, VAS, time to first rescue analgesia, total analgesic requirement, patient satisfaction and complications were recorded. Results VAS was significantly higher in ShB group at 2 and 4 h (P = 0.001 and 0.000) while it was significantly higher in ISB group at 12 h (P = 0.013). The time to first analgesic request was significantly prolonged in ISB group as compared to ShB group (8.22 h vs. 4.69 h; P = 0.002) but total analgesic requirement and patient satisfaction at 24 h were similar. Complications like dyspnoea, ptosis and motor weakness were seen only with ISB group. Conclusion Both ShB and ISB blocks have similar efficacy in terms of postoperative pain scores, cumulative analgesic requirements and patient satisfaction. However, considering the various undesirable effects associated with ISB, like phrenic nerve blockade, prolonged upper limb weakness and the occurrence of rebound pain, shoulder block may be preferred for arthroscopic shoulder surgeries.
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Affiliation(s)
- Suman Saini
- Anaesthesiology and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
| | - Shruti Mahesh Rao
- Anaesthesiology and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
| | - Nidhi Agrawal
- Anaesthesiology and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
| | - Anju Gupta
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Faiz SHR, Mohseni M, Imani F, Attaee MK, Movassaghi S, Rahimzadeh P. Comparison of Ultrasound-Guided Supra-scapular Plus Axillary Nerve Block with Interscalene Block for Postoperative Pain Management in Arthroscopic Shoulder Surgery; A Double-Blinded Randomized Open-Label Clinical Trial. Anesth Pain Med 2021; 11:e112540. [PMID: 34336619 PMCID: PMC8314074 DOI: 10.5812/aapm.112540] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/22/2021] [Accepted: 04/10/2021] [Indexed: 12/16/2022] Open
Abstract
Background Post-arthroscopic shoulder surgery pain is severe enough to interfere with initial recovery and rehabilitation. Objectives We aimed to evaluate the analgesic effects of postoperative ultrasound-guided suprascapular plus axillary nerve blocks superficial subepidermal axon bundles (SSAB) with interscalene block (ISB) in arthroscopic shoulder surgery. Methods In this single-blind randomized, open-label clinical trial, 80 candidates of elective arthroscopic shoulder surgery were randomly allocated to receive either SSAB or ISB at a postoperative care unit. The severity of resting and changing position pain was measured using visual analogue scale (VAS) score at 4h, 8h, 12h, 16h, and 24h, postoperatively. Timing of first opioid request, 24h dose requirement, patients' satisfaction rate, and side effects were also recorded. All registered data were analyzed using SPSS software version 23 for Windows (SPSS, Chicago, IL). Results Resting and changing position pain scores were comparable between SSAB and ISB groups in the most time intervals. At 12h, moving and resting pain was significantly lower in ISB than SSAB group, while moving pain was more severe in ISB group at 24h assessment. Patient satisfaction scores were comparable between the two groups except for 12h assessment. Time to first analgesic requirement and total dose of 24h opioid requirement were not significantly different between the two groups. Conclusions Suprascapular plus axillary nerve block could be an effective and safe alternative for interscalene block for pain management after arthroscopic shoulder surgery.
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Affiliation(s)
- Seyed Hamid Reza Faiz
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masood Mohseni
- Department of Anesthesiology and Pain Medicine, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamad Kazem Attaee
- Department of Anesthesiology and Pain Medicine, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Movassaghi
- Department of Anesthesiology and Pain Medicine, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran
| | - Poupak Rahimzadeh
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Saini S, Gupta A, Rao SM, Krishna B, Raheja S, Malhotra RK, Gupta DN. Comparison of Analgesic Efficacy of Ultrasound-Guided Interscalene Block Versus Continuous Subacromial Infusion for Postoperative Analgesia Following Arthroscopic Rotator Cuff Repair Surgeries: A Randomized Trial. Cureus 2021; 13:e13500. [PMID: 33777585 PMCID: PMC7990700 DOI: 10.7759/cureus.13500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Arthroscopic rotator cuff repair surgery may lead to significant postoperative pain. Interscalene block (ISB) is an effective analgesic technique in these surgeries but there is a risk of the phrenic blockade. Subacromial local anesthetic infiltration is a phrenic sparing alternative technique for postoperative analgesia. The primary aim of our study was to compare the ISB with a continuous subacromial infusion (SAC) with regard to postoperative analgesia. Methods: This prospective randomized, interventional parallel arm trial was conducted in 60 ASA grade I and II, adult patients (30 patients in each group) posted for arthroscopic rotator cuff repair surgery. Patients were randomly assigned to receive either ultrasound-guided ISB (Group ISB: 15 ml of 0.75% ropivacaine) or continuous SAC (Group SAC: 15 ml 0.75% ropivacaine as a subacromial injection by ultrasound guidance and infusion of 3 ml/hour of 0.5% ropivacaine through the catheter placed subacromial by the surgeon). Intraoperative hemodynamic parameters, visual analog scores (VAS), and rescue analgesic requirements for 24 hours, patient satisfaction, and complications were recorded. Results: Rescue analgesic requirement was significantly higher in SAC at zero hours (P=0.000), while it was significantly higher in ISB at 12 hours (P=0.02). The VAS scores were comparable at all time points and patient satisfaction at 24 hours was similar. None of the patients had rated satisfaction related to pain relief as poor in any group. Complications like ptosis and motor weakness were seen only with ISB. Conclusion: Both the techniques provided effective analgesia and comparable patient satisfaction with lesser incidence of complications in the SAC group. ISB provided more effective immediate postoperative pain relief while SAC was more effective in delayed analgesia for arthroscopic rotator cuff repair surgeries. SAC can be considered a reasonably safe alternative to ISB in patients with contraindications to the latter.
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Affiliation(s)
- Suman Saini
- Anesthesiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
| | - Anju Gupta
- Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Delhi, IND
| | - Shruti Mahesh Rao
- Anesthesia and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
| | - Bhavya Krishna
- Anesthesiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
| | - Saveena Raheja
- Anesthesia and Critical Care, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, IND
| | | | - Dr Nishkarsh Gupta
- Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Sciences, Delhi, IND
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Rothe C, Lund J, Jenstrup MT, Steen-Hansen C, Lundstrøm LH, Andreasen AM, Lange KHW. A randomized controlled trial evaluating the impact of selective axillary nerve block after arthroscopic subacromial decompression. BMC Anesthesiol 2020; 20:33. [PMID: 32005160 PMCID: PMC6995169 DOI: 10.1186/s12871-020-0952-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The sensory innervation of the shoulder is complex and there are variations in the branching patterns of the sensory fibres. Articular branches from the axillary nerve to the subacromial bursa are described in more than 50% of investigated shoulders but the isolated contribution of sensory input from the axillary nerve has never been investigated clinically. We hypothesized that a selective block of the axillary nerve would reduce morphine consumption and pain after arthroscopic subacromial decompression. METHODS We included 60 patients in a randomized, blinded, placebo-controlled study. Patients were randomized to a preoperative selective ultrasound-guided axillary nerve block with 20 mL ropivacaine (7.5 mg/mL) or 20 mL saline. Primary outcome was intravenous morphine consumption 0-4 h postoperatively. Secondary outcome was postoperative pain evaluated by a visual analogue scale (VAS) score (0-100). RESULTS We analysed data from 50 patients and found no significant difference in 0-4 h postoperative morphine consumption between the two groups (ropivacaine 14 mg, placebo 18 mg (P = 0.12)). There was a reduction in postoperative pain: VAS 0-4 h (area under the curve) (ropivacaine 135, placebo 182 (P = 0.03)), VAS after 8 h (ropivacaine 9, placebo 20 (P = 0.01)) and VAS after 24 h (ropivacaine 7, placebo 18 (P = 0.04)). Eight out of 19 patients with a successful selective axillary nerve block needed an interscalene brachial plexus escape block. CONCLUSIONS Selective block of the axillary nerve has some pain relieving effect, but in this setting the effect was unpredictable, variable and far from sufficient in a large proportion of the patients. TRIAL REGISTRATION ClinicalTrials.gov (NCT01463865). Registered: November 1, 2011.
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Affiliation(s)
- Christian Rothe
- Department of Anaesthesiology, Nordsjællands Hospital, University of Copenhagen, Dyrehavevej 29, DK-3400, Hillerød, Denmark
| | - Jørgen Lund
- Department of Anaesthesiology, Aleris-Hamlet Hospital, Copenhagen, Denmark
| | | | - Christian Steen-Hansen
- Department of Anaesthesiology, Nordsjællands Hospital, University of Copenhagen, Dyrehavevej 29, DK-3400, Hillerød, Denmark
| | - Lars Hyldborg Lundstrøm
- Department of Anaesthesiology, Nordsjællands Hospital, University of Copenhagen, Dyrehavevej 29, DK-3400, Hillerød, Denmark.
| | - Asger Mølgaard Andreasen
- Department of Anaesthesiology, Nordsjællands Hospital, University of Copenhagen, Dyrehavevej 29, DK-3400, Hillerød, Denmark
| | - Kai Henrik Wiborg Lange
- Department of Anaesthesiology, Nordsjællands Hospital, University of Copenhagen, Dyrehavevej 29, DK-3400, Hillerød, Denmark
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Choi H, Roh K, Joo M, Hong SH. Continuous suprascapular nerve block compared with single-shot interscalene brachial plexus block for pain control after arthroscopic rotator cuff repair. Clinics (Sao Paulo) 2020; 75:e2026. [PMID: 33206761 PMCID: PMC7603171 DOI: 10.6061/clinics/2020/e2026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/21/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We compared the analgesic efficacy of a continuous suprascapular nerve block (C-SSNB) and a single-shot interscalene brachial plexus block (S-ISNB) for postoperative pain management in patients undergoing arthroscopic rotator cuff repair. METHODS A total of 118 patients undergoing arthroscopic rotator cuff repair were randomly allocated to the S-ISNB or C-SSNB groups. Postoperative pain was assessed using the visual analog scale (VAS) at 1, 2, 6, 12, and 24 h postoperatively. Supplemental analgesic use was recorded as total equianalgesic fentanyl consumption. RESULTS The C-SSNB group showed significantly higher VAS scores at 0-1 h and 1-2 h after the surgery than the S-ISNB group (4.9±2.2 versus 2.3±2.2; p<0.0001 and 4.8±2.1 versus 2.4±2.3; p<0.0001, respectively). The C-SSNB group showed significantly lower VAS scores at 6-12 h after the surgery than the S-ISNB group (4.1±1.8 versus. 5.0±2.5; p=0.031). The C-SSNB group required significantly higher doses of total equianalgesic fentanyl in the post-anesthesia care unit than the S-ISNB group (53.66±44.95 versus 5.93±18.25; p<0.0001). Total equianalgesic fentanyl in the ward and total equianalgesic fentanyl throughout the hospital period were similar between the groups (145.99±152.60 versus 206.13±178.79; p=0.052 and 199.72±165.50 versus 212.15±180.09; p=0.697, respectively). CONCLUSION C-SSNB was more effective than S-ISNB at 6-12 h after the surgery for postoperative analgesia after arthroscopic rotator cuff repair.
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Affiliation(s)
- Hoon Choi
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Kyungmoon Roh
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Mina Joo
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Korea
- *Corresponding author. E-mail:
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Mejía-Terrazas GE, Ruíz-Suárez M, Vadillo-Ortega F, Franco Y Bourland RE, López-Muñoz E. Effect of interscalene nerve block on the inflammatory response in shoulder surgery: a randomized trial. J Shoulder Elbow Surg 2019; 28:e291-e303. [PMID: 31227466 DOI: 10.1016/j.jse.2019.02.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/18/2019] [Accepted: 02/27/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Comparing techniques of general anesthesia and regional anesthesia in arthroscopic shoulder surgery, some studies have shown differences in the intensity of immediate postoperative pain and neuroendocrine response, but the inflammatory response when using balanced general anesthesia (BGA) vs. an ultrasound-guided (USG) single-dose interscalene block (SDIB) has not been compared. MATERIALS AND METHODS In a single-center, prospective, randomized clinical trial, the inflammatory response of 2 groups of 10 patients scheduled to undergo arthroscopic shoulder surgery was evaluated through measurement of a panel of cytokines that act on cells of the adaptive immune response to promote or inhibit inflammation, chemokines involved in chemotaxis, the erythrocyte sedimentation rate (ESR), the high-sensitivity C-reactive protein (CRP) level, and the white blood cell (WBC) count in 3 blood samples (before anesthesia, immediately postoperatively, and 24 hours postoperatively) with 2 types of anesthesia (BGA vs. USG SDIB). Postoperative pain intensity (immediately, at 12 hours, and at 24 hours) was also assessed. RESULTS The ESR and CRP level increased significantly at 24 hours after surgery; however, the increase in ESR (P < .0001) and CRP level (P < .0001) was lower in the USG SDIB group. Significant increases in the levels of soluble interleukin 2 receptor α (P = .022) and interleukin 12p40 (P = .016) occurred in the immediate postoperative period in the USG SDIB group. Immediate postoperative pain showed a significant increase (P < .001) in the BGA group. CONCLUSIONS In arthroscopic shoulder surgery, the use of a USG SDIB compared with the use of BGA is possibly associated with improved pain control in the immediate postoperative period and lower immunosuppression, even at 24 hours after surgery.
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Affiliation(s)
| | - Michell Ruíz-Suárez
- Traumatology Service, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra," Mexico City, Mexico
| | - Felipe Vadillo-Ortega
- Unit of Vinculation, Faculty of Medicine, Universidad Nacional Autónoma de México and Laboratory of Metabolism and Nutrition in Experimental Medicine, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | | | - Eunice López-Muñoz
- Medical Research Unit in Reproductive Medicine, Unidad Médica de Alta Especialidad, Hospital de Gineco Obstetricia No. 4, "Luis Castelazo Ayala," Instituto Mexicano del Seguro Social, Mexico City, Mexico
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González-Arnay E, Jiménez-Sánchez L, García-Simón D, Valdés-Vilches L, Salazar-Zamorano CH, Boada-Pié S, Aguirre JA, Eichenberger U, Fajardo-Pérez M. Ultrasonography-guided anterior approach for axillary nerve blockade: An anatomical study. Clin Anat 2019; 33:488-499. [PMID: 31050830 DOI: 10.1002/ca.23394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/09/2019] [Accepted: 04/26/2019] [Indexed: 01/24/2023]
Abstract
Combined ultrasound (US)-guided blockade of the suprascapular and axillary nerves (ANs) has been proposed as an alternative to interscalene blockade for pain control in shoulder joint pathology or postsurgical care. This technique could help avoid respiratory complications and/or almost total upper limb palsy. Nowadays, the AN blockade is mostly performed using an in-plane caudal-to-cephalic approach from the posterior surface of the shoulder, reaching the nerve immediately after it exits the neurovascular quadrangular space (part of the spatium axillare). Despite precluding most respiratory complications, this approach has not made postsurgical pain relief any better than an interscalene blockade, probably because articular branches of the AN are not blocked.Cephalic-to-caudal methylene blue injections were placed in the first segment of the AN of six Thiel-embalmed cadavers using an US-guided anterior approach in order to compare the distribution with that produced by a posterior approach to the contralateral AN in the same cadaver. Another 21 formalin-fixed cadavers were bilaterally dissected to identify the articular branches of the AN.We found a good spread of the dye on the AN and a constant relationship of this nerve with the subscapularis muscle. The dye reached the musculocutaneous nerve, which also contributes to shoulder joint innervation. We describe the anatomical landmarks for an ultrasonography-guided anterior AN blockade and hypothesize that this anterior approach will provide better pain control than the posterior approach owing to complete blocking of the joint nerve. Clin. Anat. 33:488-499, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Emilio González-Arnay
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lorena Jiménez-Sánchez
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Diego García-Simón
- Department of Anesthesiology and Reanimation, Móstoles University Hospital, Madrid, Spain
| | - Luis Valdés-Vilches
- Department of Anesthesiology and Reanimation, Puerta del Sol Hospital, Málaga, Spain
| | | | - Sergi Boada-Pié
- Department of Anesthesiology and Reanimation, Joan XXXIII University Hospital, Tarragona, Spain
| | - José Alejandro Aguirre
- Department of Anesthesia, Intensive Care and Pain Therapy, Balgrist University Hospital, Zürich, Switzerland
| | - Urs Eichenberger
- Department of Anesthesia, Intensive Care and Pain Therapy, Balgrist University Hospital, Zürich, Switzerland
| | - Mario Fajardo-Pérez
- Department of Anatomy, Histology and Neuroscience, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,Department of Anesthesiology and Reanimation, Móstoles University Hospital, Madrid, Spain
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Sehmbi H, Johnson M, Dhir S. Ultrasound-guided subomohyoid suprascapular nerve block and phrenic nerve involvement: a cadaveric dye study. Reg Anesth Pain Med 2019; 44:561-564. [DOI: 10.1136/rapm-2018-100075] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/28/2019] [Accepted: 02/13/2019] [Indexed: 11/03/2022]
Abstract
Backgrounds and objectivesThe anterior approach to the subomohyoid suprascapular (SOS) nerve is a new, technically easy and reliable regional anesthesia technique for postoperative shoulder analgesia. However, due to its proximity, the injectate may spread to the brachial plexus and phrenic nerve. The goal of this anatomic study with dye injection in the subomohyoid space and subsequent cadaver dissection was to establish the likely spread of local anesthesia and the extent of brachial plexus and phrenic nerve involvement resulting from ultrasound-guided SOS nerve block.MethodsThe suprascapular nerve (SSN) under the inferior belly of omohyoid muscle in the posterior triangle of the neck was identified. Using a contrast dye, 10 ultrasound-guided SOS nerve injections of 5 mL were done bilaterally, in five fresh cadavers. The area was then dissected to evaluate the spread of the contrast dye in the immediate proximity of the brachial plexus, phrenic and SSN.ResultsThe SSN and omohyoid muscle were easily identified on each cadaver. SOS nerve staining with contrast dye was seen in 90% of dissections. The superior trunk was stained in 90% and the middle trunk was stained in 80% of dissections. The inferior trunk was stained in 20% of dissections. A spread of dye around the SSN was observed in 90% and the phrenic nerve was mildly stained in 20% of the dissections.ConclusionIn-plane ultrasound-guided needle injection with a 5 mL volume for SOS block was sufficient to stain the SSN. This conservative volume involved other parts of the brachial plexus and may potentially spread to the phrenic nerve. Further clinical studies are required for confirmation.
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Aliste J, Bravo D, Layera S, Fernández D, Jara Á, Maccioni C, Infante C, Finlayson RJ, Tran DQ. Randomized comparison between interscalene and costoclavicular blocks for arthroscopic shoulder surgery. Reg Anesth Pain Med 2019; 44:rapm-2018-100055. [PMID: 30635497 DOI: 10.1136/rapm-2018-100055] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/31/2018] [Accepted: 11/19/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND This randomized trial compared ultrasound-guided interscalene block (ISB) and costoclavicular brachial plexus block (CCB) for arthroscopic shoulder surgery. We hypothesized that CCB would provide equivalent analgesia to ISB 30 min after surgery without the risk of hemidiaphragmatic paralysis. METHODS All 44 patients received an ultrasound-guided block of the intermediate cervical plexus. Subsequently, they were randomized to ISB or CCB. The local anesthetic agent (20 mL of levobupivacaine 0.5% and epinephrine 5 µg/mL) and pharmacological block adjunct (4 mg of intravenous dexamethasone) were identical for all study participants. After the block performance, a blinded investigator assessed ISBs and CCBs every 5 min until 30 min using a composite scale that encompassed the sensory function of the supraclavicular nerves, the sensorimotor function of the axillary nerve and the motor function of the suprascapular nerve. A complete block was defined as one displaying a minimal score of six points (out of a maximum of eight points) at 30 min. Onset time was defined as the time required to reach the six-point minimal composite score. The blinded investigator also assessed the presence of hemidiaphragmatic paralysis at 30 min with ultrasonography.Subsequently, all patients underwent general anesthesia. Postoperatively, a blinded investigator recorded pain scores at rest at 0.5, 1, 2, 3, 6, 12, and 24 hours. Patient satisfaction at 24 hours, consumption of intraoperative and postoperative narcotics, and opioid-related side effects (eg, nausea/vomiting, pruritus) were also tabulated. RESULTS Both groups displayed equivalent postoperative pain scores at 0.5, 1, 2, 3, 6, 12, and 24 hours. ISB resulted in a higher incidence of hemidiaphragmatic paralysis (100% vs 0%; P < 0.001) as well as a shorter onset time (14.0 (5.0) vs 21.6 (6.4) minutes; p<0.001). However, no intergroup differences were found in terms of proportion of patients with minimal composite scores of 6 points at 30 min, intraoperative/postoperative opioid consumption, side effects, and patient satisfaction at 24 hours. CONCLUSION Compared to ISB, CCB results in equivalent postoperative analgesia while circumventing the risk of hemidiaphragmatic paralysis. Further confirmatory trials are required. Future studies should also investigate if CCB can provide surgical anesthesia for arthroscopic shoulder surgery. CLINICAL TRIALS REGISTRATION NCT03411343.
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Affiliation(s)
- Julián Aliste
- Department of Anesthesia, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile
| | - Daniela Bravo
- Department of Anesthesia, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile
| | - Sebastián Layera
- Department of Anesthesia, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile
| | - Diego Fernández
- Department of Anesthesia, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile
| | - Álvaro Jara
- Department of Anesthesia, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile
| | - Cristóbal Maccioni
- Department of Orthopedic Surgery, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile
| | - Carlos Infante
- Department of Orthopedic Surgery, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile
| | | | - De Q Tran
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
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Pani N, Routray SS, Pani S, Mallik S, Pattnaik S, Pradhan A. Post-operative analgesia for shoulder arthroscopic surgeries: A comparison between inter-scalene block and shoulder block. Indian J Anaesth 2019; 63:382-387. [PMID: 31142882 PMCID: PMC6530293 DOI: 10.4103/ija.ija_65_19] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Shoulder arthroscopic surgeries can produce intense post-operative pain. Inter-scalene block (ISB) provides good analgesia after shoulder surgery, but concerns over its associated risks have prompted the search for alternatives. Shoulder block (SHB), which includes suprascapular block along with axillary nerve (AN) block, was recently proposed as an alternative to ISB, but evidence of its efficacy is conflicting. The aim of our study was to compare SHB with ISB in shoulder surgery for post-operative analgesia. Methods A total of 76 patients scheduled for shoulder arthroscopic surgery were equally divided into 2 groups of 38 patients each: ISB group and SHB group. Both the nerve blocks were achieved by using ultrasound and a nerve stimulator. Visual analogue scale (VAS) scores were evaluated at 1, 4, 6, 12 and 24 h post-operatively. The time to first analgesia request, total analgesic requirement for 24 h post-operatively, patient satisfaction and any complications were recorded. Results SHB provided equivalent analgesia to ISB in terms of post-operative VAS scores. Time to first analgesic request was 6.2 ± 1.3 h in ISB group and 5.9 ± 1.2 h in SHB group, which was not statistically significant. Complications like subjective dyspnoea and weakness of arm were significantly higher in ISB group compared to SHB group. Patient satisfaction scores were also significantly higher in SHB group compared to ISB group. Conclusion SHB is as effective as ISB for post-operative pain relief and with fewer complications due to selective blockade of suprascapular and axillary nerves.
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Affiliation(s)
- Nibedita Pani
- Department of Anaesthesiology and Critical Care, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Sidharth S Routray
- Department of Anaesthesiology and Critical Care, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Soveena Pani
- Department of Anaesthesiology and Critical Care, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Soumyakanta Mallik
- Department of Anaesthesiology and Critical Care, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Santiswaroop Pattnaik
- Department of Anaesthesiology and Critical Care, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Amit Pradhan
- Department of Anaesthesiology and Critical Care, KIMS, Bhubaneswar, Odisha, India
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Kay J, Memon M, Hu T, Simunovic N, Duong A, Paul J, Athwal G, Ayeni OR. Suprascapular Nerve Blockade for Postoperative Pain Control After Arthroscopic Shoulder Surgery: A Systematic Review and Meta-analysis. Orthop J Sports Med 2018; 6:2325967118815859. [PMID: 30627589 PMCID: PMC6311591 DOI: 10.1177/2325967118815859] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Regional nerve blocks are commonly used to manage postoperative pain after arthroscopic shoulder procedures. The interscalene brachial plexus block (ISB) is commonly used; however, because of the reported side effects of ISB, the use of a suprascapular nerve block (SSNB) has been described as an alternative strategy with fewer reported side effects. Purpose: To examine the efficacy of SSNB for pain control after shoulder arthroscopy compared with ISB as well as anesthesia without a nerve block. Study Design: Systematic review; Level of evidence, 1. Methods: Three databases (PubMed, MEDLINE, and EMBASE) were searched on April 20, 2018, to systematically identify and screen the literature for randomized controlled trials (RCTs). A meta-analysis of standard mean differences (SMDs) was performed to pool the estimated effects of the nerve blocks. Results: The search identified 14 RCTs that included 1382 patients, with a mean age of 54 years (SD, 13 years). The mean follow-up time was 3 days (range, 24 hours to 6 weeks). Postoperative pain control was significantly more effective in the SSNB groups compared with the control groups within 1 hour (SMD, –0.76; 95% CI, –1.45 to –0.07; P = .03) and 4 to 6 hours (SMD, –0.81; 95% CI, –1.53 to –0.09; P = .03) postoperatively. However, pain control was significantly less effective in the SSNB groups compared with ISB within 1 hour (SMD, 0.87; 95% CI, 0.28 to 1.46; P = .004). No major complications were noted in the SSNB groups, and minor complications such as hoarseness and prolonged motor block were significantly less common for SSNB compared with ISB. Conclusion: Although not more efficacious than ISB in terms of pain control for patients undergoing shoulder arthroscopy, SSNB provides significantly improved pain control in comparison with analgesia without a nerve block. Moreover, few major and minor complications are associated with SSNB reported across the literature.
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Affiliation(s)
- Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Hu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Duong
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - George Athwal
- Roth McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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A Randomized Comparison Between Interscalene and Small-Volume Supraclavicular Blocks for Arthroscopic Shoulder Surgery. Reg Anesth Pain Med 2018; 43:590-595. [DOI: 10.1097/aap.0000000000000767] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abdolrazaghnejad A, Banaie M, Tavakoli N, Safdari M, Rajabpour-Sanati A. Pain Management in the Emergency Department: a Review Article on Options and Methods. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2018; 2:e45. [PMID: 31172108 PMCID: PMC6548151 DOI: 10.22114/ajem.v0i0.93] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT The aim of this review is to recognizing different methods of analgesia for emergency medicine physicians (EMPs) allows them to have various pain relief methods to reduce pain and to be able to use it according to the patient's condition and to improve the quality of their services. EVIDENCE ACQUISITION In this review article, the search engines and scientific databases of Google Scholar, Science Direct, PubMed, Medline, Scopus, and Cochrane for emergency pain management methods were reviewed. Among the findings, high quality articles were eventually selected from 2000 to 2018, and after reviewing them, we have conducted a comprehensive comparison of the usual methods of pain control in the emergency department (ED). RESULTS For better understanding, the results are reported in to separate subheadings including "Parenteral agents" and "Regional blocks". Non-opioids analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are commonly used in the treatment of acute pain. However, the relief of acute moderate to severe pain usually requires opioid agents. Considering the side effects of systemic drugs and the restrictions on the use of analgesics, especially opioids, regional blocks of pain as part of a multimodal analgesic strategy can be helpful. CONCLUSION This study was designed to investigate and identify the disadvantages and advantages of using each drug to be able to make the right choices in different clinical situations for patients while paying attention to the limitations of the use of these analgesic drugs.
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Affiliation(s)
- Ali Abdolrazaghnejad
- Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Banaie
- Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury research center, Iran university of medical sciences, Tehran, Iran
| | - Mohammad Safdari
- Department of Neurosurgery, Khatam-Al-Anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
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Panchamia JK, Olsen DA, Sanchez-Sotelo J, Amundson AW. Combined Selective Nerve Blockade and Local Infiltration Analgesia in a Total Shoulder Arthroplasty Patient With Chronic Pain and Severe Restrictive Lung Disease: A Case Report. ACTA ACUST UNITED AC 2017; 9:360-363. [PMID: 28767480 DOI: 10.1213/xaa.0000000000000617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Interscalene brachial plexus block is considered the most complete postoperative analgesia after total shoulder arthroplasty. Interscalene brachial plexus block-induced ipsilateral hemidiaphragmatic paralysis may not be tolerated in patients with preexisting pulmonary disease. Selective distal nerve blocks avoid the risk of phrenic nerve block; however, they may provide incomplete analgesia to the glenohumeral joint. We report a case of combined selective suprascapular and axillary nerve blockade in combination with local infiltration analgesia in a patient with severe lung disease undergoing total shoulder arthroplasty. This case highlights the local infiltration analgesia technique of the shoulder joint and current diaphragm-sparing regional anesthesia blocks.
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Affiliation(s)
- Jason K Panchamia
- From the Department of Anesthesiology and Perioperative Medicine and Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David A Olsen
- From the Department of Anesthesiology and Perioperative Medicine and Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Joaquin Sanchez-Sotelo
- From the Department of Anesthesiology and Perioperative Medicine and Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Adam W Amundson
- From the Department of Anesthesiology and Perioperative Medicine and Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Abstract
Abstract
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. This meta-analysis compares the analgesic effect and safety of suprascapular block versus interscalene block for shoulder surgery.
Methods
Databases were searched for randomized trials comparing interscalene block with suprascapular block for shoulder surgery. Postoperative 24-h cumulative oral morphine consumption and the difference in the area under curve for pooled rest pain scores were designated as primary outcomes. Analgesic and safety outcomes, particularly block-related and respiratory complications, were evaluated as secondary outcomes. Results were pooled using random-effects modeling.
Results
Data from 16 studies (1,152 patients) were analyzed. Interscalene block and suprascapular block were not different in 24-h morphine consumption. The difference in area under the curve of pain scores for the 24-h interval favored interscalene block by 1.1 cm/h, but this difference was not clinically important. Compared with suprascapular block, interscalene block reduced postoperative pain but not opioid consumption during recovery room stay by a weighted mean difference (95% CI) of 1.5 cm (0.6 to 2.5 cm; P < 0.0001). Pain scores were not different at any other time. In contrast, suprascapular block reduced the odds of block-related and respiratory complications.
Conclusions
This review suggests that there are no clinically meaningful analgesic differences between suprascapular block and interscalene block except for interscalene block providing better pain control during recovery room stay; however, suprascapular block has fewer side effects. These findings suggest that suprascapular block may be considered an effective and safe interscalene block alternative for shoulder surgery.
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Huang Y, Chiu F, Webb CA, Weyker PD. Review of the evidence: best analgesic regimen for shoulder surgery. Pain Manag 2017; 7:405-418. [PMID: 28936915 DOI: 10.2217/pmt-2017-0013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Multimodal pain management has been advocated in patients experiencing acute pain after surgical procedures due to tissue damage and the subsequent inflammatory response. For patients undergoing shoulder surgeries, studies have definitively shown that interscalene blocks (ISBs) via single-injection or continuous infusion can reduce the total opioid consumption and can lower pain scores after surgery. In some cases, ISBs can be used as the sole anesthetic during shoulder surgeries and spare patients of receiving general anesthesia. However, clinicians should be fully aware of potential pulmonary complications of ISBs and weigh the risk-benefit ratio in patients with limited pulmonary reserve.
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Affiliation(s)
- Yolanda Huang
- Department of Anesthesiology, Division of Orthopedic & Regional Anesthesia, Columbia University Medical Center
| | - Felicia Chiu
- Department of Anesthesiology, Division of Orthopedic & Regional Anesthesia, Columbia University Medical Center
| | - Christopher Aj Webb
- The Permanente Medical Group, Kaiser Permanente Northern California.,Adjunct Assistant Clinical Professor. Department of Anesthesia & Perioperative Care. University of California San Francisco School of Medicine
| | - Paul David Weyker
- Department of Anesthesiology, Divisions of Critical Care, Liver Transplant Anesthesia, Pain Medicine & Regional Anesthesia, Columbia University Medical Center
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Affiliation(s)
- Neel Desai
- Specialist Registrar in Anaesthetics, Department of Anaesthetics, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP
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Bambaren IA, Dominguez F, Elias Martin ME, Domínguez S. Anesthesia and Analgesia in the Patient with an Unstable Shoulder. Open Orthop J 2017; 11:848-860. [PMID: 29114334 PMCID: PMC5646176 DOI: 10.2174/1874325001711010848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/21/2016] [Accepted: 10/28/2016] [Indexed: 12/01/2022] Open
Abstract
Introduction: The patient with an unstable shoulder represents a challenge for the anesthesiologist. Most patients will be young individuals in good health but both shoulder dislocation reduction, a procedure that is usually performed under specific analgesia in an urgent setting, and instability surgery anesthesia and postoperative management present certain peculiarities. Material and Methods: For the purpose of the article, 78 references including clinical trials and reviews were included. The review was organized considering the patient that presents an acute shoulder dislocation and the patient with chronic shoulder instability that requires surgery. In both cases the aspects like general or regional anesthesia, surgical positions and postoperative pain management were analyzed. Conclusion: The patient with an acutely dislocated shoulder is usually managed in the emergency room. Although reduction without analgesia is often performed in non-medical settings, an appropriate level of analgesia will ease the reduction procedure avoiding further complications. Intravenous analgesia and sedation is considered the gold standard but requires appropriate monitorization and airway control. Intraarticular local analgesic injection is considered also a safe and effective procedure. General anesthesia or nerve blocks can also be considered. The surgical management of the patient with shoulder instability requires a proper anesthetic management. This should start with an exhaustive preoperative evaluation that should be focused in identifying potential respiratory problems that might be complicated by local nerve blocks. Intraoperative management can be challenging, especially for patients operated in beach chair position, for the relationship with problems related to cerebral hypoperfusion, a situation related to hypotension events directly linked to patient positioning. Different nerve blocks will help attaining excellent analgesia both during and after the surgical procedure. An interescalene nerve block should be considered the best technique, but in certain cases, other blocks can be considered.
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Affiliation(s)
| | - Fernando Dominguez
- Ramón y Cajal Hospital. Anesthesia and Intensive Care Department. Madrid. Spain
| | | | - Silvia Domínguez
- Ramón y Cajal Hospital. Anesthesia and Intensive Care Department. Madrid. Spain
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Trabelsi W, Ben Gabsia A, Lebbi A, Sammoud W, Labbène I, Ferjani M. Suprascapular block associated with supraclavicular block: An alternative to isolated interscalene block for analgesia in shoulder instability surgery? Orthop Traumatol Surg Res 2017; 103:77-83. [PMID: 27916737 DOI: 10.1016/j.otsr.2016.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 10/12/2016] [Accepted: 10/27/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Interscalene brachial plexus block (ISB) is the gold standard for postoperative pain management in shoulder surgery. However, this technique has side effects and potentially serious complications. The aim of this study was to compare the combinations of ultrasound-guided suprascapular (SSB) associated with supraclavicular nerve block (SCB) and ultrasound-guided ISB for postoperative analgesia after shoulder instability surgery. METHODS Sixty ASA physical status I-II patients scheduled to undergo shoulder instability surgery were included. Two groups: (i) the SSB+SCB group (n=30) in which the patients received a combination of US-guided SSB (15mL of bupivacaine 0.25%) and US-guided SCB (15mL of bupivacaine 0.25%) and (ii) the ISB group (n=30) in which the patients received US-guided ISB with 30mL of bupivacaine 0.25%. General anesthesia was administered to all patients. During the first 24h, the variables assessed were time to administer the anesthesia, duration of the analgesia, onset and duration of motor and sensory blockade, opioid consumption, cardiovascular stability, complications, and patient satisfaction. RESULTS Anesthesia induction took more time for the SSB+SCB group than for the ISB group. However, the onset time of motor and sensory blockade was similar in the two groups. Statistical analysis of the visual analog postoperative pain scoring at H0, H6, H12, and H24 showed nonsignificant differences between the groups. Analgesia, the first request for morphine, and total morphine consumption during the first 24h was similar in both groups. No complication was recorded in the SSB+SCB group. However, phrenic nerve block occurred in all patients in the ISB group. CONCLUSION US-guided SCB combined with US-guided SSB was as effective as ISB for postoperative analgesia after shoulder instability surgery without decreasing potential side effects. TRIAL REGISTRATION NCT identifier: NCT02397330.
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Affiliation(s)
- W Trabelsi
- Service d'anesthésie-réanimation, hôpital militaire de Gabès, 6000 Gabès, Tunisia.
| | - A Ben Gabsia
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
| | - A Lebbi
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
| | - W Sammoud
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
| | - I Labbène
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
| | - M Ferjani
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
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Casanova M, Choi S, McHardy P. Ultrasound-guided posterior cord and selective suprascapular block for shoulder surgery. Br J Anaesth 2016; 117:835. [DOI: 10.1093/bja/aew373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Suprascapular Nerve Block Versus Interscalene Block as Analgesia After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Noninferiority Trial. Arthroscopy 2016; 32:2203-2209. [PMID: 27177436 DOI: 10.1016/j.arthro.2016.03.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 02/16/2016] [Accepted: 03/10/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the efficacy of suprascapular nerve block (SSB) and interscalene block (ISB) as postoperative analgesia within the first 24 hours after arthroscopic supraspinatus and/or infraspinatus tendon repair. METHODS A single-blind, randomized controlled study was performed between 2013 and 2014. The inclusion criteria were arthroscopic supraspinatus and/or infraspinatus tendon repair confirmed intraoperatively, with or without associated procedures, and informed consent. The exclusion criteria were a previously operated shoulder, repair of the subscapularis tendon, and an allergy to local anesthetics. ISB was performed under ultrasound guidance by an anesthesiologist, whereas SSB was performed based on specific anatomic landmarks by a surgeon. The primary evaluation criterion was mean shoulder pain score during the first postoperative 24 hours assessed on a visual analog scale by the patient. The secondary criteria were complications of locoregional anesthesia, the use of analgesics in the recovery room (the first 2 hours) until postoperative day 7, and pain (visual analog scale) during the first week. Forty-four patients were needed for this noninferiority study. An institutional review board approved the study. RESULTS Seventy-four patients were randomized, and 59 met the intraoperative inclusion criteria. Six patients were excluded (1 for pneumothorax after ISB, 1 for unsuccessful SSB, and 4 for incomplete questionnaires). None of the patients were lost to follow-up. There was no significant difference between the SSB and ISB groups in mean pain score for the first 24 hours (P = .92) or the first 7 days (P = .05). However, there was significantly less pain in the ISB group in the recovery room (P = .01). Consumption of analgesics was comparable between the groups, but the SSB group took significantly more morphine in the recovery room. CONCLUSIONS In this prospective, randomized controlled study, SSB was as effective as ISB for mean pain control within the first 24 hours but ISB was more effective in relieving pain in the recovery room after arthroscopic supraspinatus and/or infraspinatus tendon repair. LEVEL OF EVIDENCE Level I, therapeutic, randomized controlled study.
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Sherman SL. Editorial Commentary: Is It Time for Surgeons to "Take Back the Block"? Do-It-Yourself Suprascapular Nerve Blocks for Arthroscopic Rotator Cuff Repair. Arthroscopy 2016; 32:2210-2211. [PMID: 27816092 DOI: 10.1016/j.arthro.2016.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 02/02/2023]
Abstract
Surgeon administered intraoperative shoulder suprascapular nerve block appears to be a safe, effective, "low tech," and inexpensive alternative to a preoperative interscalene block performed by an anesthesia provider. Surgeons should thoughtfully weigh the pros and cons of this technique and consider "taking back the block."
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Abstract
This paper is the thirty-seventh consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2014 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (endogenous opioids and receptors), and the roles of these opioid peptides and receptors in pain and analgesia (pain and analgesia); stress and social status (human studies); tolerance and dependence (opioid mediation of other analgesic responses); learning and memory (stress and social status); eating and drinking (stress-induced analgesia); alcohol and drugs of abuse (emotional responses in opioid-mediated behaviors); sexual activity and hormones, pregnancy, development and endocrinology (opioid involvement in stress response regulation); mental illness and mood (tolerance and dependence); seizures and neurologic disorders (learning and memory); electrical-related activity and neurophysiology (opiates and conditioned place preferences (CPP)); general activity and locomotion (eating and drinking); gastrointestinal, renal and hepatic functions (alcohol and drugs of abuse); cardiovascular responses (opiates and ethanol); respiration and thermoregulation (opiates and THC); and immunological responses (opiates and stimulants). This paper is the thirty-seventh consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2014 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (endogenous opioids and receptors), and the roles of these opioid peptides and receptors in pain and analgesia (pain and analgesia); stress and social status (human studies); tolerance and dependence (opioid mediation of other analgesic responses); learning and memory (stress and social status); eating and drinking (stress-induced analgesia); alcohol and drugs of abuse (emotional responses in opioid-mediated behaviors); sexual activity and hormones, pregnancy, development and endocrinology (opioid involvement in stress response regulation); mental illness and mood (tolerance and dependence); seizures and neurologic disorders (learning and memory); electrical-related activity and neurophysiology (opiates and conditioned place preferences (CPP)); general activity and locomotion (eating and drinking); gastrointestinal, renal and hepatic functions (alcohol and drugs of abuse); cardiovascular responses (opiates and ethanol); respiration and thermoregulation (opiates and THC); and immunological responses (opiates and stimulants).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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Chang KV, Hung CY, Wang TG, Yang RS, Sun WZ, Lin CP. Ultrasound-Guided Proximal Suprascapular Nerve Block With Radiofrequency Lesioning for Patients With Malignancy-Associated Recalcitrant Shoulder Pain. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:2099-2105. [PMID: 26453125 DOI: 10.7863/ultra.14.12042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/25/2015] [Indexed: 06/05/2023]
Abstract
The classic suprascapular nerve block has limitations, such as postural requirements and lack of direct nerve visualization. This series investigated the analgesic effect of ultrasound-guided supraclavicular suprascapular nerve blocks in patients with malignancy-associated shoulder pain. Ablative radiofrequency lesioning of the suprascapular nerve in 6 patients provided substantial pain relief. The mean distance from the suprascapular nerve to the brachial plexus was 8.05 mm, and the mean angle of needle entry was 20.6°. This approach appears to be effective in relieving malignancy-associated shoulder pain and is tolerated by patients unable to sit or lie prone.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, and National Taiwan University College of Medicine, Taipei, Taiwan (K.-V.C.); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Chu-Tung Branch, Hsinchu, Taiwan (C.-Y.H.); and Departments of Physical Medicine and Rehabilitation (T.-G.W.,), Orthopedic Surgery (R.-S.Y.), Anesthesiology (W.-Z.S., C.-P.L.), and Oncology (R.-S.Y., C.-P.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Yu Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, and National Taiwan University College of Medicine, Taipei, Taiwan (K.-V.C.); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Chu-Tung Branch, Hsinchu, Taiwan (C.-Y.H.); and Departments of Physical Medicine and Rehabilitation (T.-G.W.,), Orthopedic Surgery (R.-S.Y.), Anesthesiology (W.-Z.S., C.-P.L.), and Oncology (R.-S.Y., C.-P.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, and National Taiwan University College of Medicine, Taipei, Taiwan (K.-V.C.); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Chu-Tung Branch, Hsinchu, Taiwan (C.-Y.H.); and Departments of Physical Medicine and Rehabilitation (T.-G.W.,), Orthopedic Surgery (R.-S.Y.), Anesthesiology (W.-Z.S., C.-P.L.), and Oncology (R.-S.Y., C.-P.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Rong-Sen Yang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, and National Taiwan University College of Medicine, Taipei, Taiwan (K.-V.C.); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Chu-Tung Branch, Hsinchu, Taiwan (C.-Y.H.); and Departments of Physical Medicine and Rehabilitation (T.-G.W.,), Orthopedic Surgery (R.-S.Y.), Anesthesiology (W.-Z.S., C.-P.L.), and Oncology (R.-S.Y., C.-P.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Zen Sun
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, and National Taiwan University College of Medicine, Taipei, Taiwan (K.-V.C.); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Chu-Tung Branch, Hsinchu, Taiwan (C.-Y.H.); and Departments of Physical Medicine and Rehabilitation (T.-G.W.,), Orthopedic Surgery (R.-S.Y.), Anesthesiology (W.-Z.S., C.-P.L.), and Oncology (R.-S.Y., C.-P.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chih-Peng Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, and National Taiwan University College of Medicine, Taipei, Taiwan (K.-V.C.); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Chu-Tung Branch, Hsinchu, Taiwan (C.-Y.H.); and Departments of Physical Medicine and Rehabilitation (T.-G.W.,), Orthopedic Surgery (R.-S.Y.), Anesthesiology (W.-Z.S., C.-P.L.), and Oncology (R.-S.Y., C.-P.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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