Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality?
Arthroscopic shoulder surgery has a 45% incidence of severe postoperative pain. Opiates and interscalene nerve blocks have a high incidence of side effects, and intraarticular local anesthetic has been shown to be ineffective when used for postoperative pain relief. The suprascapular nerve supplies 70% of the sensory nerve supply to the shoulder joint, and local anesthetic block of this nerve is effective in certain shoulder pain disorders. To determine the efficacy of a suprascapular nerve block, subcutaneous saline was compared with a suprascapular nerve block using 10mL of 0.5% bupivacaine with 1:200,000 epinephrine before general anesthesia was induced. In the immediate postoperative period, a 51% reduction in demand and a 31% reduction in consumption of morphine delivered by a patient-controlled analgesic system was demonstrated. There was more than fivefold reduction in the incidence of nausea, as well as reduced visual analog and verbal pain scores for patients who received a suprascapular nerve block. The duration of hospital stay was reduced by 24% in the suprascapular nerve block group. A 24-h phone call interview revealed a 40% reduction in analgesic consumption and a reduction in verbal pain scores at rest and on abduction. There were no complications from the suprascapular nerve block. This study demonstrates that a suprascapular nerve block for pain relief in arthroscopic shoulder surgery is an effective and safe modality of postoperative pain relief.
Ritchie
E D
ED
Department of Anesthesia, University of Toronto, The Toronto Hospital, Ontario, Canada.
Tong
D
D
Chung
F
F
Norris
A M
AM
Miniaci
A
A
Vairavanathan
S D
SD
D000328:Adult; D000553:Ambulatory Care; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000768:Anesthesia, General; D001178:Arthroplasty; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010919:Placebos; D012540:Scapula; D012785:Shoulder Joint / Q000294:innervation* / Q000601:surgery*
D000701:Analgesics, Opioid; D010919:Placebos