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Analgesia & Resuscitation : Current Research
Research Article
Combined Suprascapular/Supraclavicular versus Interscalene Ultrasound Guided Nerve Blocks for Shoulder Arthroscopy
 
Ain Shams University, Egypt Adel Mikhail Fahmy* and Ain Shams University, Egypt Karim Youssef Kamal Hakim
 
Corresponding author : Karim Youssef Kamal Hakim, Department of Anesthesia, Faculty of Medicine, Ain Shams University, Egypt, Tel: (02)24145837;
E-mail:
karimykhakim@hotmail.com
 
Received: March 13, 2013 Accepted: April 19, 2013 Published: April 25, 2013
 
Citation: Fahmy AM, Kamal Hakim KY (2013) Combined Suprascapular/Supraclavicular versus Interscalene Ultrasound Guided Nerve Blocks for Shoulder Arthroscopy. Analg Resusc: Curr Res 2:2. doi:10.4172/2324-903X.1000105
 
Abstract
 
Background: Shoulder arthroscopy has been performed as a diagnostic tool and also as a therapeutic maneuver. Interscalene approach to the brachial plexus is the most suitable block for shoulder arthroscopy. It has a lot of complications like inadvertent epidural or intrathecal injection, vertebral artery injection, recurrent laryngeal nerve block and phrenic nerve block that may need mechanical ventilation especially in patients with respiratory compromise. Ultrasound-guided supraclavicular block was reported to be safe for shoulder arthroscopy. This approach when used for shoulder surgeries by injecting the usual volumes of local anesthetic solutions; may be unsatisfactory, so this block is augmented by block of the suprascapular nerve by ultrasound guidance. The aim of this study is to compare between the combination of ultrasoundguided suprascapular and supraclavicular nerves block versus ultrasound-guided interscalene brachial plexus block for shoulder arthroscopy as regards the efficacy of the block and the incidence of complications.
 
Methods: 60 patients ASA physical status III patients were scheduled to undergo elective shoulder arthroscopic surgery. Patients were randomly assigned to one of two groups using a computer-generated table. Group A patients received a combination of ultrasound-guided suprascapular and supraclavicular nerves block. Group B patients received ultrasound-guided interscalene nerves block. In all patients, ultrasound-guided nerve blocks were performed by using a high frequency (10-15 MHz) linear probe, sterilization of the area of skin, sterile gel for the probe and a 22-gauge spinal needle for injecting the local anesthetic solution which was a 0.25% bupivacaine solution. Success of the block and additional analgesic requirements (fentanyl increments of 50g) were recorded. If the block was failed general anesthesia was given. Any complication such as hoarseness of voice, pneumothorax, phrenic nerve affection (diagnosed by reversible shortness of breath starting within 30 minutes after injection with normal chest x-ray to exclude pneumothorax) or any other complications were recorded. Postoperative visual analogue score for pain was recorded every 4 hours for the first 24 hours. The time of first analgesic dose and total analgesics administered was recorded in the two study groups.
 
Results: Comparison between the two study groups as regards the success rate of the ultrasound-guided block to perform shoulder arthroscopy was statistically non-significant (90% in group A versus 93.3% in group B). The mean total intraoperative fentanyl administration was found to be nonsignificantly higher in group A (76.8 ± 10.7 μg) than in group B (65.9 ± 13.1 μg). There were no complications due to the block in group A patients. In group B patients, 5 out of 30 patients developed hoarseness of voice and 3 out of 30 developed unilateral phrenic nerve block; one of these patients needed support by mechanical ventilation. Statistical analysis of the visual analogue postoperative pain scoring in the first 24 hours revealed non-significant (p value>0.05) differences between the two study groups. As regards the time of first analgesic dose and the total doses given during the first 24 hours postoperative, there are no significant differences between the two groups.
 
Conclusion: The combination of ultrasound-guided suprascapular nerve and supraclavicular brachial plexus block gives success rate as ultrasound-guided interscalene brachial plexus block for shoulder arthroscopy with less complications especially in patients with respiratory compromise.
 
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