A Comparison of Subacromial Bursae Block, Suprascapular Nerve Block and Interscalene Brachial Plexus Block after Arthroscopic Shoulder Surgery

J. Ovesen, T. Falstie-Jensen, C. Christensen

Department of Anesthesiology, Randers Hospital, Randers, Denmark.
Shoulder and Elbow Clinic, Aarhus University Hospital, Aarhus, Denmark.
Shoulder and Elbow Clinic, Randers Hospital, Randers, Denmark.

DOI: 10.4236/pst.2014.23017                

Abstract

Background: The aim of this study was to compare the analgesic efficacy of subacromial bursae block (LA), suprascapular nerve block (SSB), and interscalene brachial plexus block (ISB) after arthroscopic shoulder surgery. Methods: 91 patients scheduled to undergo an arthroscopic shoulder acromioplasty under GA in an outpatient setting were included. The patients were prospectively randomized into 4 groups: 1) interscalene brachial plexus block, 2) suprascapular nerve block, 3) subacromial bursae block, 4) control group for comparison. Pain scores (VAS), supplemental analgesia, and side effects were recorded in the recoveryroom, 4 hours and 24 hours after surgery. Results: Group ISB had significantly lower pain scores at rest in the postanesthesia care unit than the SSB group (p = 0.037) and the control group (p = 0.0313). The same results were seen 4 hours follow-up. The LA group had significantly lower pain scores at rest in the postanesthesia care unit than the control group (p = 0.046) and after 4 hours follow-up significantly lower pain scores than both the SSB group (p = 0.021) and the control group (p = 0.037). After 24 hours, there were no differences between the two groups. Conclusion: In this prospective, randomized, blinded study we demonstrated that a single-dose interscalene brachial plexus block (ISB) and a subacromial bursae block (LA) are equal and the most efficient analgesic techniques after arthroscopic shoulder acromioplasty. LA is less expensive, faster and with fewer complications than ISB and therefore we suggest subacromial bursae block is an effective, safe and easy way of postoperative pain reduction after arthroscopic acromioplasty. Level of evidence: Level I. Treatment study.

Keywords

Shoulder Surgery, Pain Relief, Interscalene Block, Subacromial Bursae Block, Suprascapular Block

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Watson, W., Chung, F., Chan, V.W. and Mcgillon, M. (2004) Pain Management Following Discharge after Ambula- tory Same-Day Surgery. Journal of Nursing Management, 12, 153-161. http://dx.doi.org/10.1111/j.1365-2834.2004.00470.x
[2]	Bishop, J.Y., Spraque, M., Gelber, J., Krol, M., Rosenblatt, M.A., Gladstone, J.N. and Flatow, E.L. (2006) Interscalene Regional Anesthesia for Arthroscopic Shoulder Surgery: A Safe and Effective Technique. Journal of Shoulder and Elbow Surgery, 15, 567-570. http://dx.doi.org/10.1016/j.jse.2006.01.009
[3]	Bogdanov, A. and Loveland, R. (2005) Is There a Place for Interscalene Block Performed after Induction of General Anaesthesia? European Journal of Anaesthesiology, 22, 107-110. http://dx.doi.org/10.1017/S0265021505000207
[4]	Singelyn, F.J., Laurence, L. and Fabre, B. (2004) Pain Relief after Arthroscopic Shoulder Surgery. A Comparison of Intraqarticular Analgesia, Suprascapular Nerve Block, and Interscalene Brachial Plexus Block. Anesthesia & Analgesia, 99, 589-592. http://dx.doi.org/10.1213/01.ANE.0000125112.83117.49
[5]	Oh, J.H., Rhee, K.Y., Kim, S.H., Lee, P.B., Lee, J.W. and Lee, S.J. (2009) Comparison of Analgesic Efficacy between Single Interscalene Block Combined with Continouos Intra-Bursal Infusion of Ropivacaine and Continouos Intersca- lene Block after Arthroscopic Rotator Cuff Repair. Clinics in Orthopedic Surgery, 1, 48-53. http://dx.doi.org/10.4055/cios.2009.1.1.48
[6]	Boss, A.P., Maurer, T., Seiler, S., Aeschbach, A., Hintermann, B. and Strebel, S. (2004) Continous Subacromial Bupivacaine Infusion for Postoperative Analgesia after Open Acroimioplasty and Rotatorcuff Repair: Preliminary Re- sults. Journal of Shoulder and Elbow Surgery, 13, 630-634. http://dx.doi.org/10.1016/j.jse.2004.04.005
[7]	Ciccone, W.J., Busey, T.D., Weinstein, D.M., Walden, D.L. and Elias, J.J. (2008) Assessment of Pain Relief Provided by Interscalene Regional Block Ad Infusion Pump after Arthroscopic Shoulder Surgery. Journal of Arthroscopic & Related Surgery, 24, 14-19.
[8]	Nishiyama, T. and Komatsu, K. (2010) Local Anesthetic in Interscalene Block. Clinical Series. Minerva Anestesi- ologica, 76, 1088-1090.
[9]	Fredericson, M.J., Krishnan, S. and Chen, C.Y. (2010) Postoperative Analgesia for Shoulder Surgery. A Critical Ap- praisal and Review of Current Techniques. Anaesthesia, 65, 608-624. http://dx.doi.org/10.1111/j.1365-2044.2009.06231.x
[10]	Fredericson, M.J., Ball, C.M. and Dalgleish, A.J. (2008) Succesful Continouos Interscalen Analgesia for Ambulatory Shoulder Surgery in a Private Practice Setting. Regional Anesthesia and Pain Medicine, 33, 122-128. http://dx.doi.org/10.1097/00115550-200803000-00006
[11]	Nisar, A., Morris, M.W., Freeman, J.V., Cort, J.M., Rayner, P.R. and Hahane, S.A. (2008) Subacromial Bursae Block Is an Effective Alternative to Interscalene Block for Postoperative Pain Control after Artroscopic Subacromial Decom- pression: A Randomized Trial. Journal of Shoulder and Elbow Surgery, 17, 78-84. http://dx.doi.org/10.1016/j.jse.2007.05.014
[12]	Borgeat, A. and Ekatodramis, G. (2002) Anaesthesia for Shoulder Surgery. Best Practice & Research Clinical Anaesthesiology, 16, 211-225. http://dx.doi.org/10.1053/bean.2002.0234
[13]	Faryniarz, D., Morelli, C., Coleman, S., Holmes, T., Allen, A., Altchek, D., Cordasco, F., Warren, R.F., Urban, M.K. and Gordon, M.A. (2006) Interscalene Block Anesthesia at an Ambulatory Surgery Center Performing Predominantly Regional Anesthesia: A Prospective Study of One Hundred Thirty-Three Patients Undergoing Shoulder Surgery. Jour- nal of Shoulder and Elbow Surgery, 15, 686-690. http://dx.doi.org/10.1016/j.jse.2006.02.001
[14]	Laurila, P.A., Lopponen, A., Kanga-Saarela, T., Flinkkila, T. and Salomaki, T.E. (2002) Interscalene Brachial Plexus Block Is Superior to Subacromial Bursa Block after Arthroscopic Shoulder Surgery. Acta Anaesthesiologica Scandinavica, 46, 1031-1036. http://dx.doi.org/10.1034/j.1399-6576.2002.460818.x
[15]	Stiglitz, Y., Gosselin, O., Sedaghatian, J., Sirveaux, F. and Mole, D. (2011) Pain after Shoulder Surgery. A Prospective Study on 231 Cases. Orthopaedics and Traumatology, 97, 260-266.
[16]	Wilson, A.T., Nicholson, E., Burton, L. and Wild, C. (2004) Analgesia for One-Day Shoulder Surgery. British Journal of Anaesthesia, 92, 414-415. http://dx.doi.org/10.1093/bja/aeh071
[17]	Wurm, W.H., Concepcion, M., Sternlicht, A., Carabuena, J.M., Robelen, G., Goudas, L.C., Strassels, S.A. and Carr, D.B. (2003) Preoperative Interscalene Block for Elective Shoulder Surgery: Loss of Benefit over Early Postoperative Block after Patient Discharge to Home. Anesthesia & Analgesia, 97, 1620-1626. http://dx.doi.org/10.1213/01.ANE.0000090320.46129.BE
[18]	Clendenen, S.R., Robards, C.B., Wang, R.D. and Greengrass, R.A. (2009) Continous Interscalene Block Associated with Neck Hematoma and Postoperative Sepsis. Anesthesia-Analgesia, 9.
[19]	Cohen, J.M. and Gray, A.T. (2010) Functional Deficit after Intraneural Injection during Interscalene Block. Regional Anesthesia and Pain Medicine, 35, 397-399. http://dx.doi.org/10.1097/AAP.0b013e3181e8a35f
[20]	Eroglu, A., Uzunlar, H., Sener, M., Akinturk, Y. and Erciyes, N. (2004) A Clinical Comparison of Equal Concentration and Volume of Ropivacaine and Bupivacain for Interscalene Brachial Plexus Anesthesis and Analgesia in Shoulder Surgery. Regional Anesthesia and Pain Medicine, 29, 539-543. http://dx.doi.org/10.1097/00115550-200411000-00006
[21]	Lenters, T.R., Davies, J. and Matsen, F.A. (2007) The Types and Severety of Complications Associated with Intersca- lene Brachial Plexus Block Anesthesia: Local and National Evidence. Journal of Shoulder and Elbow Surgery, 16, 379-387. http://dx.doi.org/10.1016/j.jse.2006.10.007
[22]	Liu, S.S., Zayas, V.M., Gordon, M.A., Beathe, J.C., Maalouf, D.B., Paroli, L., Liguori, G.A., Ortiz, J., Buschiazzo, V., Ngeow, J., Shetty, T. and Ya Deau, J.T. (2009) A Prospective, Randomized, Controlled Trial Comparing Ultrasound versus Nerve Stimulator Guidance for Interscalene Block for Ambulatory Shoulder Surgery for Postoperative Neuro- logical Symptoms. Anesthesia & Analgesia, 109, 266-271. http://dx.doi.org/10.1213/ane.0b013e3181a3272c
[23]	McNaught, A., Shastri, U., Camichael, N., Awad, I.T., Columb, M., Cheung, J., Holtby, R.M. and McCartney, C.J. (2011) Ultrasound Reduces the Minimum Effective Local Anaesthetic Volume Compared with Peripheral Nerve Stimulation for Interscalene Block. British Journal of Anaesthesia, 106, 124-130. http://dx.doi.org/10.1093/bja/aeq306
[24]	Spencer, S.L., Victor, M.Z., Gordon, M.A., Maalouf, D.B., Paroli, L., Liguori, G.A., Ortiz, J., Buschiazzo, V., Ngeow, J., Shetty, T. and Ya Deau ,T.Y. (2008) Aprospective, Randomized, Controlled Trial Comparing Ultrasound versus Nervestimulator Guidance for Interscalene Block for Ambulatory Shoulder Surgery for Postoperative Neurological Symptoms. Anesthesia-Analgesia, 8.