Single-shot suprascapular nerve block and superior trunk block have been reported to provide a noninferior analgesic effect after shoulder surgery with a lesser incidence of hemidiaphragmatic paresis compared with interscalene brachial plexus block. This study hypothesized that continuous suprascapular nerve block provides noninferior analgesia with minimal effects on diaphragmatic movement compared with continuous superior trunk block in patients undergoing arthroscopic shoulder surgery.
100 patients were randomized undergoing arthroscopic shoulder surgery between December 2020 and October 2021 into continuous suprascapular nerve block and continuous superior trunk block groups. Before the surgery, patients received either a single-shot superior trunk block or subomohyoid suprascapular nerve block. Thereafter, a superior trunk catheter was inserted by anesthesiologists in patients in the continuous superior trunk block group, and a posterior suprascapular nerve catheter was inserted with arthroscopic assistance during the surgery by surgeon in the continuous suprascapular nerve block group. The primary outcome was the postoperative pain score at postoperative 24 h, and the incidence of hemidiaphragmatic paresis was also compared.
Overall, 98 patients were included in the final analysis. The worst and resting pain scores at postoperative 24 h in the continuous suprascapular nerve block group were inferior compared with those in the continuous superior trunk block group in the test with a noninferiority margin of 1 (worst pain score: mean difference, 0.9; 95% CI, 0.1 to 1.7; resting pain score: mean difference, 0.5; 95% CI, 0.0 to 1.0). However, the continuous suprascapular nerve block group had a significantly lower incidence of hemidiaphragmatic paresis at postoperative 24 h than the continuous superior trunk block group.
Continuous suprascapular nerve block provides statistically inferior analgesia compared to the continuous superior trunk block; however, the continuous suprascapular nerve block had a minimal effect on the phrenic nerve function.
- Traditional regional techniques for anesthetizing the shoulder almost uniformly block the ipsilateral phrenic nerve
- Alternative more distal regional techniques have been tested to provide shoulder analgesia without phrenic block, with variable success
- A direct comparison between ultrasound-guided continuous superior trunk block placed by an anesthesiologist provided statistically superior analgesia compared to continuous suprascapular nerve block arthroscopically placed by a surgeon
- Continuous suprascapular block was associated with less frequent ipsilateral phrenic block compared to a continuous superior trunk block
- Personalized judgments about the most relevant risks (uncontrolled pain vs. pulmonary insufficiency) and benefits (denser analgesia vs. maintenance of bilateral diaphragmatic excursion) of each individual patient may be informed by these contrasting findings