Skip to main content

Advertisement

SpringerLink
Log in

Blind suprascapular and axillary nerve block for post-operative pain in arthroscopic rotator cuff surgery

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The goal of the study was to evaluate the efficacy of additional axillary nerve block (ANB) with suprascapular nerve block (SSNB) and patient-controlled anaesthesia (PCA) with no device assistance after arthroscopic rotator cuff repair. The hypothesis is that patients with intravenous (IV) PCA and the blockade of the two main nerves (SSNB + ANB) experienced lesser pain than patients with IV PCA or IV PCA + SSNB.

Methods

The 114 patients undergoing arthroscopic rotator cuff repair were allocated randomly to three groups as follows: group I, intravenous PCA pumps (only PCA); group II, IV PCA + SSNB using a blind technique (PCA + SSNB); and group III, IV PCA + SSNB + ANB using a blind technique (PCA + SSNB + ANB). Pain visual analogue scale (VAS) scores were evaluated at 1, 6, 12, 24, 36, and 48 post-operative hours. Furthermore, the degree of pain was compared according to cuff tear size.

Results

The pain VAS score of group III was lower than that of the other two groups and was significantly lower at post-operative hours 1, 6, and 12. In addition, the larger cuff tear tended to be indicative of greater pain. However, all groups experienced rebound pain.

Conclusion

PCA + SSNB + ANB using a blind technique is a better pain control method than PCA + SSNB and only PCA during the initial 12 post-operative hours. PCA + SSNB + ANB is a cost-effective, time-saving, and easily performed method for post-operative pain control as an axis of multimodal pain control strategy.

Level of evidence

II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Al-Nasser B (2012) Review of interscalene block for postoperative analgesia after shoulder surgery in obese patients. Acta Anaesthesiol Taiwan 50:29–34

    Article  PubMed  Google Scholar 

  2. Barber FA (2005) Suprascapular nerve block for shoulder arthroscopy. Arthroscopy 21(8):1015

    Article  PubMed  Google Scholar 

  3. Bishop JY, Sprague M, Gelber J, Krol M, Rosenblatt MA, Gladstone J, Flatow EL (2005) Interscalene regional anesthesia for shoulder surgery. J Bone Joint Surg Am 87(5):974–979

    PubMed  Google Scholar 

  4. Borghi B, Facchini F, Agnoletti V, Adduci A, Lambertini A, Marini E, Gallerani P, Sassoli V, Luppi M, Casati A (2006) Pain relief and motor function during continuous interscalene analgesia after open shoulder surgery: a prospective, randomized, double-blind comparison between levobupivacaine 0.25 %, and ropivacaine 0.25 % or 0.4 %. Eur J Anaesthesiol 23(12):1005–1009

    Article  CAS  PubMed  Google Scholar 

  5. Casati A, Borghi B, Fanelli G, Montone N, Rotini R, Fraschini G, Vinciguerra F, Torri G, Chelly J (2003) Interscalene brachial plexus anesthesia and analgesia for open shoulder surgery: a randomized, double-blinded comparison between levobupivacaine and ropivacaine. Anesth Analg 96(1):253–259

    CAS  PubMed  Google Scholar 

  6. Checcucci G, Allegra A, Bigazzi P, Gianesello L, Ceruso M, Gritti G (2008) A new technique for regional anesthesia for arthroscopic shoulder surgery based on a suprascapular nerve block and an axillary nerve block: an evaluation of the first results. Arthroscopy 24(6):689–696

    Article  PubMed  Google Scholar 

  7. Cho CH, Song KS, Min BW, Jung GH, Lee YK, Shin HK (2015) Efficacy of interscalene block combined with multimodal pain control for postoperative analgesia after rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 23(2):542–547

    Article  PubMed  Google Scholar 

  8. Chung F, Ritchie E, Su J (1997) Postoperative pain in ambulatory surgery. Anesth Analg 85(4):808–816

    Article  CAS  PubMed  Google Scholar 

  9. Cummings KC 3rd, Napierkowski DE, Parra-Sanchez I, Kurz A, Dalton JE, Brems JJ, Sessler DI (2011) Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. Brit J Anaesth 107(3):446–453

    Article  CAS  PubMed  Google Scholar 

  10. DeOrio JK, Cofield RH (1984) Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am 66(4):563–567

    Article  CAS  PubMed  Google Scholar 

  11. Dragoo JL, Braun HJ, Kim HJ, Phan HD, Golish SR (2012) The in vitro chondrotoxicity of single-dose local anesthetics. Am J Sport Med 40(4):794–799

    Article  Google Scholar 

  12. Dyhre H, Lang M, Wallin R, Renck H (1997) The duration of action of bupivacaine, levobupivacaine, ropivacaine and pethidine in peripheral nerve block in the rat. Acta Anaesth Scand 41(10):1346–1352

    Article  CAS  PubMed  Google Scholar 

  13. Elsharkawy HA, Abd-Elsayed AA, Cummings KC 3rd, Soliman LM (2014) Analgesic efficacy and technique of ultrasound-guided suprascapular nerve catheters after shoulder arthroscopy. Ochsner J 14(2):259–263

    PubMed  PubMed Central  Google Scholar 

  14. Faryniarz D, Morelli C, Coleman S, Holmes T, Allen A, Altchek D, Cordasco F, Warren RF, Urban MK, Gordon MA (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. J Shoulder Elbow Surg 15(6):686–690

    Article  PubMed  Google Scholar 

  15. Fontana C, Di Donato A, Di Giacomo G, Costantini A, De Vita A, Lancia F, Caricati A (2009) Postoperative analgesia for arthroscopic shoulder surgery: a prospective randomized controlled study of intraarticular, subacromial injection, interscalenic brachial plexus block and intraarticular plus subacromial injection efficacy. Eur J Anaesthesiol 26(8):689–693

    Article  PubMed  Google Scholar 

  16. Fortier J, Chung F, Su J (1998) Unanticipated admission after ambulatory surgery—a prospective study. Can J Anaesth 45(7):612–619

    Article  CAS  PubMed  Google Scholar 

  17. Fredrickson MJ, Krishnan S, Chen CY (2010) Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia 65(6):608–624

    Article  CAS  PubMed  Google Scholar 

  18. Han SS, Lee YH, Oh JH, Aminzai S, Kim SH (2013) Randomized, controlled trial of multimodal shoulder injection or intravenous patient-controlled analgesia after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 21(12):2877–2883

    Article  PubMed  Google Scholar 

  19. Jerosch J, Saad M, Greig M, Filler T (2008) Suprascapular nerve block as a method of preemptive pain control in shoulder surgery. Knee Surg Sports Traumatol Arthrosc 16(6):602–607

    Article  CAS  PubMed  Google Scholar 

  20. Lee JJ, Yoo YS, Hwang JT, Kim DY, Jeon SJ, Hwang SM, Jang JS (2013) Efficacy of direct arthroscopy-guided suprascapular nerve block after arthroscopic rotator cuff repair: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 23:562–566

    Article  CAS  PubMed  Google Scholar 

  21. Lee SM, Park SE, Nam YS, Han SH, Lee KJ, Kwon MJ, Ji JH, Choi SK, Park JS (2012) Analgesic effectiveness of nerve block in shoulder arthroscopy: comparison between interscalene, suprascapular and axillary nerve blocks. Knee Surg Sports Traumatol Arthrosc 20:2573–2578

    Article  PubMed  Google Scholar 

  22. Lenters TR, Davies J, Matsen FA 3rd (2007) The types and severity of complications associated with interscalene brachial plexus block anesthesia: local and national evidence. J Shoulder Elbow Surg 16:379–387

    Article  PubMed  Google Scholar 

  23. Misamore G, Webb B, McMurray S, Sallay P (2011) A prospective analysis of interscalene brachial plexus blocks performed under general anesthesia. J Shoulder Elbow Surg 20(2):308–314

    Article  PubMed  Google Scholar 

  24. Moore D (1979) Block of the suprascapular nerve. In: Thomas CC (ed) Regional nerve block 4th edn. Charles C Thomas, Springfield, Illinois, pp 300–303

  25. Nam YS, Jeong JJ, Han SH, Park SE, Lee SM, Kwon MJ, Ji JH, Kim KS (2011) An anatomic and clinical study of the suprascapular and axillary nerve blocks for shoulder arthroscopy. J Shoulder Elbow Surg 20(7):1061–1068

    Article  PubMed  Google Scholar 

  26. Oh JH, Rhee KY, Kim SH, Lee PB, Lee JW, Lee SJ (2009) Comparison of analgesic efficacy between single interscalene block combined with a continuous intra-bursal infusion of ropivacaine and continuous interscalene block after arthroscopic rotator cuff repair. Clin Orthop Surg 1:48–53

    Article  PubMed  PubMed Central  Google Scholar 

  27. Park JY, Lee GW, Kim Y, Yoo MJ (2002) The efficacy of continuous intrabursal infusion with morphine and bupivacaine for postoperative analgesia after subacromial arthroscopy. Reg Anesth Pain Med 27(2):145–149

    Article  CAS  PubMed  Google Scholar 

  28. Price DJ (2007) The shoulder block: a new alternative to interscalene brachial plexus blockade for the control of postoperative shoulder pain. Anaesth Intensive Care 35(4):575–581

    CAS  PubMed  Google Scholar 

  29. Price DJ (2008) Axillary (circumflex) nerve block used in association with suprascapular nerve block for the control of pain following total shoulder joint replacement. Reg Anesth Pain Med 33(3):280–281

    Article  PubMed  Google Scholar 

  30. Ritchie ED, Tong D, Chung F, Norris AM, Miniaci A, Vairavanathan SD (1997) Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality? Anesth Analg 84(6):1306–1312

    Article  CAS  PubMed  Google Scholar 

  31. Robaux S, Bouaziz H, Boisseau N, Raucoules-Aime M, Laxenaire MC, Service SOSRHL (2001) Persistent phrenic nerve paralysis following interscalene brachial plexus block. Anesthesiology 95(6):1519–1521

    Article  Google Scholar 

  32. Rothe C, Steen-Hansen C, Lund J, Jenstrup MT, Lange KH (2014) Ultrasound-guided block of the suprascapular nerve—a volunteer study of a new proximal approach. Acta Anaesth Scand 58(10):1228–1232

    Article  CAS  PubMed  Google Scholar 

  33. Savoie FH, Field LD, Jenkins RN, Mallon WJ, Phelps RA 2nd (2000) The pain control infusion pump for postoperative pain control in shoulder surgery. Arthroscopy 16(4):339–342

    Article  CAS  PubMed  Google Scholar 

  34. Shin SW, Byeon GJ, Yoon JU, Ok YM, Baek SH, Kim KH, Lee SJ (2014) Effective analgesia with ultrasound-guided interscalene brachial plexus block for postoperative pain control after arthroscopic rotator cuff repair. J Anesth 28(1):64–69

    Article  PubMed  Google Scholar 

  35. Singh A, Kelly C, O’Brien T, Wilson J, Warner JJ (2012) Ultrasound-guided interscalene block anesthesia for shoulder arthroscopy: a prospective study of 1319 patients. J Bone Joint Surg Am 94(22):2040–2046

    Article  PubMed  Google Scholar 

  36. Tuominen M, Pitkanen M, Rosenberg PH (1987) Postoperative pain relief and bupivacaine plasma levels during continuous interscalene brachial plexus block. Acta Anaesth Scand 31(4):276–278

    Article  CAS  PubMed  Google Scholar 

  37. Turker G, Demirag B, Ozturk C, Uckunkaya N (2004) Cardiac arrest after interscalene brachial plexus block in the sitting position for shoulder arthroscopy: a case report. Acta Orthop Belg 70(1):84–86

    PubMed  Google Scholar 

  38. Weber SC, Jain R (2002) Scalene regional anesthesia for shoulder surgery in a community setting: an assessment of risk. J Bone Joint Surg Am 84-A(5):775–779

    Article  PubMed  Google Scholar 

  39. Whiteside JB, Wildsmith JA (2001) Developments in local anaesthetic drugs. Brit J Anaesth 87(1):27–35

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors appreciate Yoo-Kyung Hwang Ph.D. for providing assistance in performing statistical analysis.

Author information

Authors and Affiliations

  1. NEON Orthopaedic Center, Seoul, South Korea

    Jin-Young Park

  2. Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea

    Jin-Young Bang

  3. Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, South Korea

    Kyung-Soo Oh

Authors
  1. Jin-Young Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jin-Young Bang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyung-Soo Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin-Young Bang.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, JY., Bang, JY. & Oh, KS. Blind suprascapular and axillary nerve block for post-operative pain in arthroscopic rotator cuff surgery. Knee Surg Sports Traumatol Arthrosc 24, 3877–3883 (2016). https://doi.org/10.1007/s00167-015-3902-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3902-3

Keywords

Search

Navigation