Efficacy of Suprascapular-Axillary Nerve Block versus Interscalene Brachial Plexus Block for Postoperative Pain Management in Shoulder Surgery

Abstract

Background: Shoulder surgeries are commonly associated with significant postoperative pain. Adequate pain management is essential for optimal patient outcomes. Conventionally, interscalene brachial plexus block is used for shoulder surgery, but it is associated with potential complications, such as phrenic nerve palsy, direct intrathecal injection. The combined suprascapular-axillary nerve block technique may offer a safe alternative with a more targeted analgesic effect, potentially reducing complications and allowing early recovery. The main objective was to compare the analgesic efficacy of combined suprascapular-axillary nerve block with interscalene brachial plexus block for postoperative pain management in shoulder surgery.
Methods: This prospective, randomized controlled trial was carried out in the Orthopedics operation theatre, Bangladesh Medical University. Sixty patients scheduled for elective shoulder surgery were enrolled. Participants were randomized into two groups: Group SA received combined suprascapular axillary nerve block and Group I received interscalene brachial plexus block. Postoperative pain scores were assessed using the Visual Analogue Scale (VAS) immediately at recovery, 4h, 8h, 12h, and 24h. Time to rescue analgesic, opioid consumption, respiratory rate and hemodynamic parameters were recorded and patient satisfaction were assessed on a 5-point Likert scale after 24 hours.
Results: Postoperative pain intensity by Visual Analogue Scale (VAS) score was higher in Group SA compared to Group I at 8 hours (3.07±0.82 vs 3.50±0.63, p=0.04) & at 24 hours pain remained lower in the group SA compared to the group I (1.57±0.62 vs 1.90±0.40, p=0.010), both was statistically significant, at other point of VAS scores are non-significant. Time of first rescue analgesic request was longer in Group I compared to Group SA (495 minutes vs.352.5 minutes, p=0.559), but difference was not statistically significant and postoperative 24-hour morphine consumption were similar in both groups. Hemodynamic parameters remained stable and comparable throughout the perioperative period but at 24 hours postoperatively, the group I showed a significantly higher MAP than the group SA (90.0±5.72 vs. 84.83±12.39 mmHg, p=0.003). The respiratory rate remained stable and comparable between both groups. Patient satisfaction scores did not differ significantly between the groups.
Conclusion: Suprascapular-axillary block is comparable to interscalene brachial plexus block in providing effective postoperative pain relief following shoulder surgery.