Onset and recovery of ultrasound guided out-of-plane versus in-plane interscalene block in arthroscopic shoulder surgery

Abstract

BackgroundThe aim of this study was to assess the out-of-plane versus the in-plane approaches for the interscalene brachial plexus block, as regards the performance time, the onset, the progression and the recovery of sensory block, the onset and progression of the motor block as well as, the postoperative pain score, and the duration of analgesia for arthroscopic shoulder surgery. A total of 60 patients of American Society of Anesthesiologists (ASA) physical status I-II were randomly divided to receive either the in-plane approach (group I), or the out-of-plane approach (group O).ResultsThe block performance time was statistically significant shorter in group O. The onset of sensory block was statistically significant faster in group O. The progression of sensory block over the first 20 min was statistically significant fast for C5 and C6 nerve roots in group O. The motor block showed statistically and clinically significant rapid onset and progression in group O. All patients in group O and group I felt no pain in the post-anesthesia care unit (PACU), and the first call for analgesia was at 24 h in both groups.ConclusionThe out-of-plane approach offers short performance time, rapid onset and progression of sensory and motor blocks, as well as postoperative analgesic effect lasting for 24 h in arthroscopic shoulder surgery.