Ultrasound-guided suprascapular nerve and costoclavicular brachial plexus block for athroscopic shoulder surgery

초록

Background Several diaphragm sparing nerve blocks were evaluated. In this study, we compared ultrasound guided interscalene block(ISB) with combined proximal suprascapular nerve block(SSNB) and costoclavicular block(CCB) for arthroscopic shoulder surgery. Hypotheses We hypothesized that combined SSNB-CCB was non-inferior to ISB in terms of immediate postoperative analgesia for arthroscopic shoulder surgery with a reduced risk of hemidiaphragmatic paralysis(HDP). Methods Adult inpatients (20 ? 80 years of age, American Society of Anesthesiologists physical status 1 ? 3) scheduled for arthroscopic shoulder surgery were included. Patients were randomly assigned to receive either ISB (group I) or combined SSNB-CCB (group SC). ? The primary outcome : pain score at 30 min in the PACU ? The secondary outcomes: pain score (6hr, 24hr), worst pain score(WP), supplemental analgesia (IV morphine equivalents), incidence of HDP, block related outcomes (performance time, patient discomfort, motor block, block duration), adverse events (vascular puncture, LA toxicity, and unintentional paresthesia) Results Group SC was not inferior to the group I in terms of the primary outcome (P = 0.987, the difference of the medians, 0; 95% CI 0 - 0). The pain scores at other time points were not significantly different between the groups (Fig. 2). Supplemental analgesia was not significantly different in both groups at PACU and 24 hr (Table 2). Complete or partial HDP occurred in a higher incidence in group I than group SC (73% vs 8%; P < 0.001). Block-procedure time was longer in combined block compared to ISB. Other secondary outcomes were comparable in both groups(Table 3). Discussion This study shows that combined SSNB-CCB was non-inferior to ISB in terms of pain score at 30 min in PACU, the primary outcome, and subsequent pain scores were similar in both groups. The overall incidence of HDP with combined block was lower than that with ISB.