Work

Ultrasound-guided suprascapular nerve block with hydrodilatation of the suprascapular nerve sheath offers few adverse events and is non-inferior to interscalene brachial plexus blocks for postoperative opiate sparing: a prospective randomized trial

Year: 2025

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: BACKGROUND: Interscalene brachial plexus block (ISB) is the standard regional analgesic technique for shoulder surgery. Given its adverse event profile, We conducted a randomized controlled trial to compare the analgesic efficacy and postoperative outcomes between the combined suprascapular nerve block (SSnb) and ultrasound-guided selective shoulder anterior capsular block (SHAC; hereinafter referred to as SHAC-SSnb) versus ultrasound-guided ISB. METHODS: A total of sixty patients (American Society of Anesthesiologists Score 1-3, age 18-65 years old) scheduled for elective arthroscopic shoulder surgery were randomly assigned to receive either a SHAC-SSnb or ISB. The primary outcomes were pain intensity, at rest and movement, and incidence of adverse events in the first 48 hours postoperatively. RESULTS: During the first 4 hours postoperatively, the 95% confidence intervals for the between-group differences in numerical rating scale (NRS) pain scores crossed the prespecified non-inferiority margin of 1.3 points, indicating that non-inferiority could not be established in the immediate postoperative period. After 8 hours, the distinction was no longer noticeable. Over the course of 48 hours, the disparity between the two groups was minimal, and the confidence interval included 0, thus resulting in a finding of noninferiority. Although opioid consumption was comparable between the groups, the incidence of dyspnea and discomfort related to muscle weakness was higher in the ISB group. CONCLUSION: SHAC-SSnb was inferior to ISB in the first 4 hours (NRS difference >2.0) but achieved non-inferiority after 8 hours. SHAC-SSnb is non-inferior to ISB in terms of opioid requirement over the 48-hour postoperative period. Patients who received the SHAC-SSnb nerve block had a lower proportion of patient-reported dyspnea and muscle weakness-related discomfort. LIMITATION: Small sample size and subjective dyspnea assessment warrant cautious interpretation.

Source: International Journal of Surgery

DOI: 10.1097/js9.0000000000004115