Effects of arthroscopy-guided suprascapular nerve block combined with ultrasound-guided interscalene brachial plexus block for arthroscopic rotator cuff repair: a randomized controlled trial.
OBJECTIVE
The aim of this study was to compare the pain relieving effect of ultrasound-guided interscalene brachial plexus block (ISB) combined with arthroscopy-guided suprascapular nerve block (SSNB) with that of ultrasound-guided ISB alone within the first 48 h after arthroscopic rotator cuff repair.


METHODS
Forty-eight patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled. The 24 patients in group 1 received ultrasound-guided ISB and arthroscopy-guided SSNB; the remaining 24 patients in group 2 underwent ultrasound-guided ISB alone. Visual analogue scale pain score and patient satisfaction score were checked at 1, 3, 6, 12, 18, 24, and 48 h post-operatively.


RESULTS
Group 1 had a lower visual analogue scale pain score at 3, 6, 12, 18, 24, and 48 h post-operatively (1.7 < 2.6, 1.6 < 4.0, 3.5 < 5.8, 3.6 < 5.2, 3.2 < 4.2, 1.3 < 2.0), and a higher patient satisfaction score at 6, 12, 18, 24, and 36 h post-operatively than group 2 (7.8 > 6.0, 6.2 > 4.3, 6.4 > 5.1, 6.9 > 5.9, 7.9 > 7.1). Six patients in group 1 developed rebound pain twice, and the others in group 1 developed it once. All of the patients in group 2 had one rebound phenomenon each (p = 0.010). The mean timing of rebound pain in group 1 was later than that in group 2 (15.5 > 9.3 h, p < 0.001), and the mean size of rebound pain was smaller in group 1 than that in group 2 (2.5 > 4.0, p = 0.001).


CONCLUSIONS
Arthroscopy-guided SSNB combined with ultrasound-guided ISB resulted in lower visual analogue scale pain scores at 3-24 and 48 h post-operatively, and higher patient satisfaction scores at 6-36 h post-operatively with the attenuated rebound pain compared to scores in patients who received ultrasound-guided ISB alone after arthroscopic rotator cuff repair. The combined blocks may relieve post-operative pain more effectively than the single block within 48 h after arthroscopic cuff repair.


METHODS
Randomized controlled trial, Level I. ClinicalTrials.gov Identifier: NCT02424630.
Anesthesiology and Pain Medicine, College of Medicine, Hallym University, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea.
Jae Jun
JJ
Lee
Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea. drakehjt@hanmail.net.|Orthopedic Biomechanics Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA. drakehjt@hanmail.net.
Jung-Taek
JT
Hwang
Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea.
Do-Young
DY
Kim
Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea.
Sang-Soo
SS
Lee
Anesthesiology and Pain Medicine, College of Medicine, Hallym University, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea.
Sung Mi
SM
Hwang
Anesthesiology and Pain Medicine, College of Medicine, Hallym University, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea.
Na Rea
NR
Lee
Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea.
Byung-Chan
BC
Kwak
D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001182:Arthroscopy / Q000379:methods; D065527:Brachial Plexus Block; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010149:Postoperative Pain; D017060:Patient Satisfaction; D000070636:Rotator Cuff Injuries / Q000601:surgery*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D000779:Anesthetics, Local
Arthroscopic rotator cuff repair; Interscalene brachial plexus block; Post-operative pain; Suprascapular nerve block