Newly Published
Pain Medicine  |   October 2017
Suprascapular and Interscalene Nerve Block for Shoulder Surgery: A Systematic Review and Meta-analysis
Author Notes
  • From the Central Michigan University College of Medicine, Mt. Pleasant, Michigan (N.H., G.G., N.R.); Department of Clinical Epidemiology, McMaster University, Hamilton, Ontario, Canada (L.B.); Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (J.G.L., F.W.A.); Department of Anesthesia and Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada (J.G.L., F.W.A.); Department of Anesthesia, School of Medicine, National University of Ireland, Galway, Ireland (J.G.L.); and Department of Anesthesiology and Pain Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (F.W.A.).
  • Submitted for publication May 8, 2017. Accepted for publication August 31, 2017.
    Submitted for publication May 8, 2017. Accepted for publication August 31, 2017.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Research Support: Supported by the Merit Award Program, Department of Anesthesia, University of Toronto (Toronto, Ontario, Canada; to Drs. Abdallah and Laffey).
    Research Support: Supported by the Merit Award Program, Department of Anesthesia, University of Toronto (Toronto, Ontario, Canada; to Drs. Abdallah and Laffey).×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Abdallah: Department of Anesthesia, St. Michael’s Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada. abdallahf@smh.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Pain Medicine / Pain Medicine / Regional Anesthesia
Pain Medicine   |   October 2017
Suprascapular and Interscalene Nerve Block for Shoulder Surgery: A Systematic Review and Meta-analysis
Anesthesiology Newly Published on October 12, 2017. doi:10.1097/ALN.0000000000001894
Anesthesiology Newly Published on October 12, 2017. doi:10.1097/ALN.0000000000001894
Abstract

Background: Interscalene block provides optimal shoulder surgery analgesia, but concerns over its associated risks have prompted the search for alternatives. Suprascapular block was recently proposed as an interscalene block alternative, but evidence of its comparative analgesic effect is conflicting. This meta-analysis compares the analgesic effect and safety of suprascapular block versus interscalene block for shoulder surgery.

Methods: Databases were searched for randomized trials comparing interscalene block with suprascapular block for shoulder surgery. Postoperative 24-h cumulative oral morphine consumption and the difference in the area under curve for pooled rest pain scores were designated as primary outcomes. Analgesic and safety outcomes, particularly block-related and respiratory complications, were evaluated as secondary outcomes. Results were pooled using random-effects modeling.

Results: Data from 16 studies (1,152 patients) were analyzed. Interscalene block and suprascapular block were not different in 24-h morphine consumption. The difference in area under the curve of pain scores for the 24-h interval favored interscalene block by 1.1 cm/h, but this difference was not clinically important. Compared with suprascapular block, interscalene block reduced postoperative pain but not opioid consumption during recovery room stay by a weighted mean difference (95% CI) of 1.5 cm (0.6 to 2.5 cm; P < 0.0001). Pain scores were not different at any other time. In contrast, suprascapular block reduced the odds of block-related and respiratory complications.

Conclusions: This review suggests that there are no clinically meaningful analgesic differences between suprascapular block and interscalene block except for interscalene block providing better pain control during recovery room stay; however, suprascapular block has fewer side effects. These findings suggest that suprascapular block may be considered an effective and safe interscalene block alternative for shoulder surgery.