Comparative evaluation of regional blockades during arthroscopic shoulder surgery

Objective: To evaluate the effectiveness of interscalene brachial plexus block versus combined suprascapular and axillary nerves block for shoulder arthroscopy. Methods: In this prospective study 174 patients were operated on the shoulder joint by the arthroscopic method under combined anesthesia. In the 1st group (n=96), for the purpose of analgesia, patients got interscalene brachial plexus block; in the 2nd group (n=78), patients received suprascapular and axillary nerves block. Ultrasound visualization and neurostimulation were used in both groups. Recorded the time from the start of blockade to the start of the operation, as well as the duration of the sensory and motor blockade. The intensity of postoperative pain was assessed with a 10-point Numeric rating scale, the need for additional analgesia, the quality of night sleep, and patient comfort. Neurological complications were also recorded.

Results: There were no differences in the time from the admit patients to the operating room and before the start surgery. The analgesic effect in the early postoperative period in the 1st group was higher, but by the end of the first day there was no statistical difference between the groups in the intensity of the pain syndrome. Intake of non-narcotic and narcotic analgesics was higher in the 2nd group. Complications were noted only for the 1st group: diaphragm paresis in 6 (6.25%) patients, in 2 (2.08%) – recurrent laryngeal nerve blockade. Satisfaction with postoperative analgesia was 100% in patients of the 2nd group. The choice of regional anesthesia for arthroscopic interventions on the shoulder did not affect the length of hospitalization.

Conclusion: Selective anesthesia of the suprascapular and axillary nerves during shoulder arthroscopic surgery is an alternative of interscalene brachial plexus block; it is not associated by respiratory and neurological complications; does not violate movements in the distal upper limb, reduces psychological discomfort and anxiety of patients.