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Anterior Suprascapular Nerve Block Versus Interscalene Brachial Plexus Block for Shoulder Surgery in the Outpatient Setting: A Randomized Controlled Patient- and Assessor-Blinded Trial.
Reg Anesth Pain Med. 2017 May/Jun; 42(3):310-318.RA

Abstract

BACKGROUND AND OBJECTIVES

The interscalene brachial plexus block (ISB), a potent option to control pain after shoulder surgery, has notable adverse effects. The anterior suprascapular nerve block (SSNB) might provide comparable analgesia and cause less grip-strength impairment. These characteristics were studied in this randomized controlled patient- and assessor-blinded trial.

METHODS

Outpatients were randomized to single-shot ultrasound-guided SSNB (10 mL ropivacaine 1%) or ISB (20 mL ropivacaine 0.75%) before general anesthesia for arthroscopic shoulder surgery. Pain (Numerical Rating Scale, 0-10), grip strength, degree of satisfaction, and strength of recommendation were assessed.

RESULTS

We randomized 168 patients to each group and analyzed 164 in the SSNB group and 165 in the ISB group. Nerve blocks were successful in 98% of the patients from each group. Both procedures provided good postoperative analgesia, and the mean pain level for SSNB was slightly but significantly lower by 0.32 units (95% confidence interval, 0.18-0.46; P < 0.001) and noninferior given a margin of 1.1 units; P < 0.001. Within the first 24 hours, 162 (99%) of SSNB patients had unimpaired grip strength compared to 81 (49%) of ISB patients (P < 0.001). The multiple primary outcome, superior unimpaired grip strength, and noninferior pain control was significant; P < 0.001. Compared to ISB patients (n = 130 [79%]), significantly more SSNB patients (n = 150 [91%]) were satisfied/highly satisfied. Patients in the SSNB group were more likely to recommend the procedure highly.

CONCLUSIONS

For outpatients undergoing arthroscopic shoulder surgery under general anesthesia, the SSNB seems preferable to ISB. It provides excellent postoperative analgesia without exposing patients to impaired mobility and to risks of the more potent but also more invasive ISB.

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Authors+Show Affiliations

Wiegel M
From the *Department of Anesthesiology, ACQUA Clinic, Leipzig, Germany; †Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Innsbruck Medical University, Innsbruck, Austria; ‡Department of Anesthesiology, Intensive Care Medicine, Pain Therapy and Palliative Medicine, Sana Hospital, Borna, Germany; §Clinical Trial Centre, University of Leipzig, Leipzig, Germany; ∥Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany; and **Department of Anesthesiology and Intensive Care Medicine, Heinrich-Braun-Hospital Zwickau, Zwickau, Germany.
Moriggl B
No affiliation info available
Schwarzkopf P
No affiliation info available
Petroff D
No affiliation info available
Reske AW
No affiliation info available

MeSH

AdultAgedAmbulatory Surgical ProceduresArthroscopyAutonomic Nerve BlockBrachial Plexus BlockDouble-Blind MethodFemaleHumansMaleMiddle AgedPain, PostoperativeScapulaShoulder

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28257388

Clinical Trial Links

Clinical And Anatomic Study Of An Ultrasound-Guided Superior Trunk Of The Brachial Plexus
Ultrasound-Guided Erector Spinae Plane Block or Interscalen Brachial Plexus Block Following Arthroscopic Shoulder Surgery
Ultrasound-Guided Erector Spinae Plane Block Following Upper Extremity Surgery
Anterior Suprascapular Nerve Block is an Effective and Diaphragm Protective Approach for Arthroscopic Shoulder Surgery

Citation

Wiegel, Martin, et al. "Anterior Suprascapular Nerve Block Versus Interscalene Brachial Plexus Block for Shoulder Surgery in the Outpatient Setting: a Randomized Controlled Patient- and Assessor-Blinded Trial." Regional Anesthesia and Pain Medicine, vol. 42, no. 3, 2017, pp. 310-318.
Wiegel M, Moriggl B, Schwarzkopf P, et al. Anterior Suprascapular Nerve Block Versus Interscalene Brachial Plexus Block for Shoulder Surgery in the Outpatient Setting: A Randomized Controlled Patient- and Assessor-Blinded Trial. Reg Anesth Pain Med. 2017;42(3):310-318.
Wiegel, M., Moriggl, B., Schwarzkopf, P., Petroff, D., & Reske, A. W. (2017). Anterior Suprascapular Nerve Block Versus Interscalene Brachial Plexus Block for Shoulder Surgery in the Outpatient Setting: A Randomized Controlled Patient- and Assessor-Blinded Trial. Regional Anesthesia and Pain Medicine, 42(3), 310-318. https://doi.org/10.1097/AAP.0000000000000573
Wiegel M, et al. Anterior Suprascapular Nerve Block Versus Interscalene Brachial Plexus Block for Shoulder Surgery in the Outpatient Setting: a Randomized Controlled Patient- and Assessor-Blinded Trial. Reg Anesth Pain Med. 2017 May/Jun;42(3):310-318. PubMed PMID: 28257388.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anterior Suprascapular Nerve Block Versus Interscalene Brachial Plexus Block for Shoulder Surgery in the Outpatient Setting: A Randomized Controlled Patient- and Assessor-Blinded Trial. AU - Wiegel,Martin, AU - Moriggl,Bernhard, AU - Schwarzkopf,Peter, AU - Petroff,David, AU - Reske,Andreas W, PY - 2017/3/4/pubmed PY - 2018/9/12/medline PY - 2017/3/4/entrez SP - 310 EP - 318 JF - Regional anesthesia and pain medicine JO - Reg Anesth Pain Med VL - 42 IS - 3 N2 - BACKGROUND AND OBJECTIVES: The interscalene brachial plexus block (ISB), a potent option to control pain after shoulder surgery, has notable adverse effects. The anterior suprascapular nerve block (SSNB) might provide comparable analgesia and cause less grip-strength impairment. These characteristics were studied in this randomized controlled patient- and assessor-blinded trial. METHODS: Outpatients were randomized to single-shot ultrasound-guided SSNB (10 mL ropivacaine 1%) or ISB (20 mL ropivacaine 0.75%) before general anesthesia for arthroscopic shoulder surgery. Pain (Numerical Rating Scale, 0-10), grip strength, degree of satisfaction, and strength of recommendation were assessed. RESULTS: We randomized 168 patients to each group and analyzed 164 in the SSNB group and 165 in the ISB group. Nerve blocks were successful in 98% of the patients from each group. Both procedures provided good postoperative analgesia, and the mean pain level for SSNB was slightly but significantly lower by 0.32 units (95% confidence interval, 0.18-0.46; P < 0.001) and noninferior given a margin of 1.1 units; P < 0.001. Within the first 24 hours, 162 (99%) of SSNB patients had unimpaired grip strength compared to 81 (49%) of ISB patients (P < 0.001). The multiple primary outcome, superior unimpaired grip strength, and noninferior pain control was significant; P < 0.001. Compared to ISB patients (n = 130 [79%]), significantly more SSNB patients (n = 150 [91%]) were satisfied/highly satisfied. Patients in the SSNB group were more likely to recommend the procedure highly. CONCLUSIONS: For outpatients undergoing arthroscopic shoulder surgery under general anesthesia, the SSNB seems preferable to ISB. It provides excellent postoperative analgesia without exposing patients to impaired mobility and to risks of the more potent but also more invasive ISB. SN - 1532-8651 UR - https://www.unboundmedicine.com/medline/citation/28257388/Anterior_Suprascapular_Nerve_Block_Versus_Interscalene_Brachial_Plexus_Block_for_Shoulder_Surgery_in_the_Outpatient_Setting:_A_Randomized_Controlled_Patient__and_Assessor_Blinded_Trial_ L2 - https://rapm.bmj.com/lookup/pmidlookup?view=long&amp;pmid=28257388 DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓26]

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