title: Effect of ultrasonographically guided axillary nerve block combined with suprascapular nerve block in arthroscopic rotator cuff repair: a randomized controlled trial.
abstract: OBJECTIVE
  The aim of this study was to compare the results of ultrasonographically guided axillary nerve block (ANB) combined with suprascapular nerve block (SSNB) with those of SSNB alone on postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair.
  
  
  METHODS
  Forty-two patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this study. Among them, 21 patients were randomly allocated to group 1 and received both SSNB and ANB with 10 mL ropivacaine. The other 21 patients were allocated to group 2 and received SSNB with 10 mL 0.75% ropivacaine and ANB with 10 mL saline. Visual analog scale (VAS) pain score, patient satisfaction (SAT), and lateral pain index (LPI) was checked at 1, 3, 6, 12, 18, 24, 36, and 48 hours postoperatively.
  
  
  RESULTS
  Group 1 showed a significantly lower mean VAS score at postoperative 1, 3, 6, 12, 18, and 24 hours compared with group 2 (5.1 < 7.6, 4.4 < 6.3, 3.7 < 5.3, 3.2 < 4.5, 2.7 < 4.0, and 2.7 < 3.4, respectively). A significantly high mean SAT and low mean LPI was observed in group 1 at postoperative 1, 3, 6, 12, 18, 24, and 36 hours (4.9 > 2.4, 5.9 > 3.7, 6.3 > 5.0, 6.8 > 5.7, 7.3 > 6.2, 7.5 > 6.6, and 7.7 > 7.0, respectively), (1.1 < 3.0, 0.8 < 2.5, 0.7 < 2.0, 0.7 < 1.6, 0.6 < 1.3, 0.6 < 1.0, and 0.4 < 0.7, respectively). The frequency of rebound pain decreased in group 1 compared with group 2 (P = .032). In addition, rebound phenomenon showed a correlation with ANB on univariate logistic regression (P = .034; odds ratio, 0.246).
  
  
  CONCLUSIONS
  Ultrasonographically guided ANB combined with SSNB in arthroscopic rotator cuff repair showed an improved mean VAS in the first 24 hours after surgery compared with SSNB alone. The mean SAT and LPI of the combined blocks were better than those of the single block within the first 36 hours. Ultrasonographically guided ANB combined with SSNB also decreased the rebound phenomenon.
  
  
  METHODS
  Level I, randomized controlled trial.
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea.
authors.forename: Jae Jun
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea; Institute for Skeletal Aging and Orthopedic Surgery, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea.
authors.forename: Do-Young
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea; Institute for Skeletal Aging and Orthopedic Surgery, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea. Electronic address: drakehjt@hanmail.net.
authors.forename: Jung-Taek
authors.initials: JT
authors.lastname: Hwang
authors.affiliation: Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea; Institute for Skeletal Aging and Orthopedic Surgery, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea.
authors.forename: Sang-Soo
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea.
authors.forename: Sung Mi
authors.initials: SM
authors.lastname: Hwang
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea.
authors.forename: Gi Ho
authors.initials: GH
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea.
authors.forename: Yoon-Geol
authors.initials: YG
authors.lastname: Jo
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001182:Arthroscopy; D001917:Brachial Plexus; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D000077212:Ropivacaine; D017006:Rotator Cuff / Q000294:innervation / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012782:Shoulder / Q000000981:diagnostic imaging* / Q000294:innervation*; D014463:Ultrasonography
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine