Newly Published
Perioperative Medicine  |   April 2018
Comparison of Anterior Suprascapular, Supraclavicular, and Interscalene Nerve Block Approaches for Major Outpatient Arthroscopic Shoulder Surgery: A Randomized, Double-blind, Noninferiority Trial
Author Notes
  • From the Virginia Mason Medical Center, Seattle, Washington (D.B.A., N.A.H., R.S.J., S.C.Y.); the Washington Permanente Medical Group, Seattle, Washington (B.E.S.); and Axio Research, Seattle, Washington (A.E.S.).
  • Submitted for publication November 28, 2017. Accepted for publication February 27, 2018.
    Submitted for publication November 28, 2017. Accepted for publication February 27, 2018.×
  • Acknowledgments: The authors would like to acknowledge: Genna L. Saunders, R.N., research nurse, Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, for assisting with screening and data collection; and Joshuel A. Pahang, B.S., research assistant, Department of Anesthesiology, Virginia Mason Medical Center, for assisting with randomization, screening, and data collection.
    Acknowledgments: The authors would like to acknowledge: Genna L. Saunders, R.N., research nurse, Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, for assisting with screening and data collection; and Joshuel A. Pahang, B.S., research assistant, Department of Anesthesiology, Virginia Mason Medical Center, for assisting with randomization, screening, and data collection.×
  • Research Support: Support was provided solely from institutional and/or departmental sources.
    Research Support: Support was provided solely from institutional and/or departmental sources.×
  • Competing Interests: Dr. Auyong has previously received honoraria from FujiFilm SonoSite (Bothell, Washington), research funding from Fujifilm Sonosite, and honoraria from Halyard Health (Alpharetta, Georgia), but nothing related in any way to the research presented here. The other authors declare competing interests.
    Competing Interests: Dr. Auyong has previously received honoraria from FujiFilm SonoSite (Bothell, Washington), research funding from Fujifilm Sonosite, and honoraria from Halyard Health (Alpharetta, Georgia), but nothing related in any way to the research presented here. The other authors declare competing interests.×
  • Reproducible Science: Full protocol available at: david.auyong@virginiamason.org. Raw data available at: david.auyong@virginiamason.org.
    Reproducible Science: Full protocol available at: david.auyong@virginiamason.org. Raw data available at: david.auyong@virginiamason.org.×
  • Portions of this study were presented at both the 41st Annual Regional Anesthesiology and Acute Pain Medicine Meeting, New Orleans, Louisiana on April 2, 2016 (primary outcome), and the 42nd Annual Regional Anesthesiology and Acute Pain Medicine Meeting, San Francisco, California on April 7, 2017 (24-h outcomes).
    Portions of this study were presented at both the 41st Annual Regional Anesthesiology and Acute Pain Medicine Meeting, New Orleans, Louisiana on April 2, 2016 (primary outcome), and the 42nd Annual Regional Anesthesiology and Acute Pain Medicine Meeting, San Francisco, California on April 7, 2017 (24-h outcomes).×
  • Correspondence: Address correspondence to Dr. Auyong: Virginia Mason Medical Center, 1100 Ninth Ave, MS: B2-AN, Seattle, Washington 98101. david.auyong@virginiamason.org. 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
Perioperative Medicine / Ambulatory Anesthesia / Pain Medicine / Regional Anesthesia / Respiratory System
Perioperative Medicine   |   April 2018
Comparison of Anterior Suprascapular, Supraclavicular, and Interscalene Nerve Block Approaches for Major Outpatient Arthroscopic Shoulder Surgery: A Randomized, Double-blind, Noninferiority Trial
Anesthesiology Newly Published on April 9, 2018. doi:10.1097/ALN.0000000000002208
Anesthesiology Newly Published on April 9, 2018. doi:10.1097/ALN.0000000000002208
Abstract

Background: The interscalene nerve block provides analgesia for shoulder surgery, but is associated with diaphragm paralysis. One solution may be performing brachial plexus blocks more distally. This noninferiority study evaluated analgesia for blocks at the supraclavicular and anterior suprascapular levels, comparing them individually to the interscalene approach.

Methods: One hundred-eighty-nine subjects undergoing arthroscopic shoulder surgery were recruited to this double-blind trial and randomized to interscalene, supraclavicular, or anterior suprascapular block using 15 ml, 0.5% ropivacaine. The primary outcome was numeric rating scale pain scores analyzed using noninferiority testing. The predefined noninferiority margin was one point on the 11-point pain scale. Secondary outcomes included opioid consumption and pulmonary assessments.

Results: All subjects completed the study through the primary outcome analysis. Mean pain after surgery was: interscalene = 1.9 (95% CI, 1.3 to 2.5), supraclavicular = 2.3 (1.7 to 2.9), suprascapular = 2.0 (1.4 to 2.6). The primary outcome, mean pain score difference of supraclavicular–interscalene was 0.4 (–0.4 to 1.2; P = 0.088 for noninferiority) and of suprascapular–interscalene was 0.1 (–0.7 to 0.9; P = 0.012 for noninferiority). Secondary outcomes showed similar opioid consumption with better preservation of vital capacity in the anterior suprascapular group (90% baseline [P < 0.001]) and the supraclavicular group (76% [P = 0.002]) when compared to the interscalene group (67%).

Conclusions: The anterior suprascapular block, but not the supraclavicular, provides noninferior analgesia compared to the interscalene approach for major arthroscopic shoulder surgery. Pulmonary function is best preserved with the anterior suprascapular nerve block.