Suprascapular and Interscalene Nerve Block as Analgesia After Arthroscopic Rotator Cuff Repair: a Retrospective Comparative Cohort Study

Keywords: Rotator cuff tear, interscalene block, suprascapular nerve block, arthroscopic repair

Abstract

Introduction: This study aimed to compare the efficacy of interscalene block (ISB) and suprascapular nerve block (SSNB), individually and in combination (ISB+SSNB), used as postoperative analgesia within the first 3 hours after arthroscopic rotator cuff repair. Materials and Methods: Retrospective comparative cohort study, conducted between 2019 and 2021. The primary endpoint was shoulder pain score in the immediate postoperative period as reported on a visual analog scale (VAS) by the patient. Secondary endpoints were opioid use in the recovery room (first 3 hours) and locoregional anesthesia complications. Results: 175 patients were included; 13 in the ISB group, 61 in the ISB+SSNB group, and 101 in the SSNB group. The ISB group and the ISB+SSNB group had significantly less pain in the recovery room than the SSNB group (p = 0.001 and p < 0.001, respectively). The percentage of patients who required at least one dose of opioid and the total number of opioids consumed in milligrams of morphine equivalent were significantly lower for the ISB and ISB+SSNB groups than for the SSNB group (p < 0.001). There were no significant differences in pain or opioid use between ISB alone or combined with SSNB (ISB+SSNB). Conclusions: In this retrospective comparative study, ISB was more effective in relieving pain and reducing opioid use in the recovery room after arthroscopic rotator cuff repair than SSNB. The ISB+SSNB combination did not increase effectiveness, and therefore it is suggested not to combine these two techniques.

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Author Biographies

Jorge Rojas Lievano, Shoulder and Elbow Section, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia
Shoulder and Elbow Section, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia
Mercedes Salas, Shoulder and Elbow Section, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia
Shoulder and Elbow Section, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia
Corina Salas, School of Medicine, Universidad de La Sabana, Bogota, Colombia
School of Medicine, Universidad de La Sabana, Bogota, Colombia
Ana María Suarez, Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia
Department of Anesthesiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia
Guido Fierro, Shoulder and Elbow Section, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia
Shoulder and Elbow Section, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia
Juan Carlos González, Shoulder and Elbow Section, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia
Shoulder and Elbow Section, Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia

References

Suárez LJM, Fierro G, González GJC. Dolor postoperatorio en cirugía de reparación del manguito rotador mini

abierto y artroscópico bajo protocolo de analgesia multimodal. Rev Colomb Ortop Traumatol 2020;34(2):144-50.

https://doi.org/10.1016/j.rccot.2020.06.015

Uquillas CA, Capogna BM, Rossy WH, Mahure SA, Rokito AS. Postoperative pain control after arthroscopic

rotator cuff repair. J Shoulder Elbow Surg 2016;25(7):1204-13. https://doi.org/10.1016/j.jse.2016.01.026

Kay J, Memon M, Hu T, Simunovic N, Duong A, Paul J, et al. Suprascapular nerve blockade for postoperative

pain control after arthroscopic shoulder surgery: A systematic review and meta-analysis. Orthop J Sport Med

;6(12):1-17. https://doi.org/10.1177/2325967118815859

Pizzi LT, Toner R, Foley K, Thomson E, Chow W, Kim M, et al. Relationship between potential opioid-related

adverse effects and hospital length of stay in patients receiving opioids after orthopedic surgery. Pharmacotherapy 2012;32(6):502-14. https://doi.org/10.1002/j.1875-9114.2012.01101.x

Kim H, Kim HJ, Lee ES, Lee S, Park JH, Kim H, et al. Postoperative pain control after arthroscopic rotator cuff

repair: Arthroscopy-guided continuous suprascapular nerve block versus ultrasound-guided continuous interscalene block. Arthroscopy 2021;37(11):3229-37. https://doi.org/10.1016/j.arthro.2021.04.067

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(44):e27661. https://doi.org/10.1097/MD.0000000000027661.7

Salviz EA, Xu D, Frulla A, Kwofie K, Shastri U, Chen J, et al. Continuous interscalene block in patients having

outpatient rotator cuff repair surgery: A prospective randomized trial. Anesth Analg 2013;117(6):1485-92.

https://doi.org/10.1213/01.ane.0000436607.40643.0a

Desroches A, Klouche S, Schlur C, Bauer T, Waitzenegger T, Hardy P. Suprascapular nerve block versus

interscalene block as analgesia after arthroscopic rotator cuff repair: A randomized controlled noninferiority trial. Arthroscopy 2016;32(11):2203-9. https://doi.org/10.1016/j.arthro.2016.03.013

Kim JH, Koh HJ, Kim DK, Lee HJ, Kwon KH, Lee KY, et al. Interscalene brachial plexus bolus block versus

patient-controlled interscalene indwelling catheter analgesia for the first 48 hours after arthroscopic rotator cuff

repair. J Shoulder Elbow Surg 2018;27(7):1243-50. https://doi.org/10.1016/j.jse.2018.02.048

Kim YS, Lee HJ, Park I, Im JH, Park KS, Lee SB. Are delayed operations effective for patients with rotator cuff

tears and concomitant stiffness? An analysis of immediate versus delayed surgery on outcomes. Arthroscopy

;31(2):197-204. https://doi.org/10.1016/j.arthro.2014.08.014

Koga R, Funakoshi T, Yamamoto Y, Kusano H. Suprascapular nerve block versus interscalene block for analgesia after arthroscopic rotator cuff repair. J Orthop 2019;19:28-30. https://doi.org/10.1016/j.jor.2019.11.013

Published
2023-08-17
How to Cite
Rojas Lievano, J., Salas, M., Salas, C., Suarez, A. M., Fierro, G., & González, J. C. (2023). Suprascapular and Interscalene Nerve Block as Analgesia After Arthroscopic Rotator Cuff Repair: a Retrospective Comparative Cohort Study. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(4), 379-385. https://doi.org/10.15417/issn.1852-7434.2023.88.4.1594
Section
Clinical Research

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