Effect of liposomal bupivacaine for the suprascapular nerve combined with axillary nerve block on postoperative analgesia in patients undergoing shoulder surgery: a randomized, observer-blinded trial

ESRA19-0518 Strategies to reduce hemidiaphragmatic paresis and related risks after blocks/for shoulder surgery

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.

Author Reply to “Regarding ‘Postoperative Pain Control After Arthroscopic Rotator Cuff Repair: Arthroscopy-Guided Continuous Suprascapular Nerve Block Versus Ultrasound-Guided Continuous Inter-Scalene Block’”

Subscapularis and sub-omohyoid plane blocks: an alternative to peripheral nerve blocks for shoulder analgesia

Background &amp; objective: Inter-scalene brachial plexus block (ISB) is the gold standard for postoperative pain management in shoulder surgery. Although, this method has its side-effects and possibly complications. Supra-scapular nerve block and axillary nerve block have also been used in upper limb procedures. We compared ISB with the blockade of supra-scapular and axillary nerves (called shoulder block) for postoperative analgesia after shoulder arthroscopic surgical operation under ultrasound guidance (USG) and nerve stimulators.&#x0D; Methodology: It was a prospective, randomized, comparative study.&#x0D; Results: The VAS pain scores at different times postoperatively were not significantly different between the ISB and ShB groups (P = t 0.071, 0.28, 0.378, 0.358, 0.451 at 2, 4, 8, 16, and 24 h respectively. VAS 0 was significantly difference (P = 0.029) but still the VAS score was less than 3, so no pain killers were given.&#x0D; Conclusion: Ultrasound guided supra-scapular and axillary nerve blocks ae equally effective as inter-scalene brachial plexus block for postoperative analgesia in shoulder arthroscopic surgery with less side-effects.&#x0D; Abbreviations: ANB: Axillary Nerve Block; ISB: Interscalene Block; MAC: Minimum OR: Operating Room; REC: Research Ethics Committee; ShB: Shoulder Block; SSB: Supra-scapular Nerve Block; VAS: Visual Analogue Scale&#x0D; Citation: Elbermway MS, Elshantory SF, Aly RM, Mahran MG. Comparison between supra-scapular nerve block combined with axillary nerve block and interscalene brachial plexus block for postoperative analgesia following shoulder arthroscopy. Anaesth. pain intensive care 2022;26(5):674−680; DOI: 10.35975/apic.v26i5.2026&#x0D;

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

ESRA19-0710 Ambulatory regional anaesthesia-tips and tricks

Continuous plexus and peripheral nerve blocks for postoperative analgesia.

BackgroundThe interscalene brachial plexus block has been used effectively for intraoperative and postoperative analgesia in patients undergoing shoulder surgery, but it is associated with high rates of diaphragmatic dysfunction. Performing...

Objective: to comparatively evaluate the analgesic activity and hemostatic effects of two nonsteroidal anti-inflammatory drugs (NSAID) that are most commonly used for postoperative analgesia — ketorolac and ketoprofen in patients operated on for diffuse nodular nontoxic goiter. Subjects and methods. At surgical treatment stages, the authors examined the degree of the pain syndrome by the visual analog scale and hemostatic parameters in 90 patients divided into three groups according to the postoperative analgesia mode (ketorol, ketonal, and promedol). Results. Postoperative analgesia in nontoxic goiter patients with ketorol and ketonal has been ascertained to be highly competitive with that with promedol and to give no rise to clinically significant complications inherent in NSAID. Ketorol provides a rapider, prolonged and effective postoperative analgesia than does ketonal. Ketorol affects the hemostatic system to a lesser extent than does ketonal. Conclusion. Ketorol analgesia may be considered to be the method of choice of postoperative analgesia in patients with nontoxic goiter. Key words: ketorol, ketonal, hemostasis, analgesia.

An anatomic and clinical study of the suprascapular and axillary nerve blocks for shoulder arthroscopy

A commentary on “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. 94 (2021) 106111

To explore the impact of quadratus lumborum block (QLB) combined with butorphanol-based patient-controlled intravenous analgesia (PCIA) on intraoperative opioid use, postoperative analgesia, and recovery indicators in patients undergoing colorectal tumor surgery. A retrospective analysis was conducted on 78 patients who underwent radical resection of colorectal tumors. Based on postoperative analgesia strategies, patients were divided into two groups: the QLB combined with butorphanol PCIA group (QB group, n = 38) and the butorphanol PCIA group (B group, n = 40). Parameters compared between groups included intraoperative sufentanil consumption, postoperative Visual Analog Scale (VAS) scores, hemodynamic and respiratory indicators, recovery time, Mini-Cognitive Evaluation Scale (MESS) scores, incidence of adverse reactions, and lower limb motor function. The QB group had significantly lower total and hourly intraoperative sufentanil consumption than the B group (P = 0.014). VAS scores were significantly lower in the QB group from 30 minutes to 6 hours postoperatively (P < 0.05). Additionally, the QB group showed more stable intraoperative heart rate (HR) and mean arterial pressure (MAP), along with higher partial pressure of end-tidal carbon dioxide (PETCO2) levels. Cognitive function, as measured by MESS scores at 24, 48, and 72 hours postoperatively, was significantly better in the QB group (P < 0.05). However, the B group experienced shorter times to orientation recovery, extubation, spontaneous breathing, and overall awakening. Lower limb muscle strength scores were comparable between groups, with no observed impairments in ambulation. The overall incidence of adverse reactions did not differ significantly between groups (QB group: 5.26% vs. B group: 7.5%; P > 0.05). QLB combined with butorphanol-based PCIA effectively enhances early postoperative analgesia and promotes hemodynamic and respiratory stability in patients undergoing colorectal tumor surgery, supporting its broader application for postoperative analgesia in this patient population.

This study aims to investigate the effects of suprascapular nerve and axillary nerve block on postoperative pain, tramadol consumption, sevoflurane consumption and visual clarity of the surgical field in arthroscopic shoulder surgery. Forty-six patients undergoing arthroscopic shoulder surgery were randomized to receive either both suprascapular and axillary nerve block with ultrasound guidance (20 ml 0.25% bupivacaine) before general anesthesia (group SSAXB, n=23) or a subacromial local infiltration (20 ml 0.25% bupivacaine) after the procedure (group control, n=23). End-tidal sevoflurane consumption, visualization of the arthroscopic field scores of the patients were recorded during the procedure. The patient's postoperative pain scores (at PACU, 4, 8, 12, 24 hours after the surgery) and tramadol consumption were also recorded. End-tidal sevoflurane concentration values were similar in both groups (p>0.05). Group SSAXB had a better mean static pain score in the PACU (Group SSAXB 4.27±1.48 vs Group C 6.24±1.09 p<0.05). Tramadol consumption was lower in group SSAXB than in group C (253.1±85.3 mg vs 324.2±72 mg, p=0.005). Visual clarity scores of the arthroscopic field were higher in group SSAXB than in group C along the intraoperative period (p<0.05). SSAXB are effective in postoperative analgesia, reduce tramadol consumption and provide a clean image in the arthroscopic area of arthroscopic shoulder surgery, but these blocks do not reduce sevoflurane consumption.

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.