Combined suprascapular nerve block and axillary nerve block approach vs. peri-articular infiltration analgesia for postoperative pain management following arthroscopic shoulder surgery: a randomized clinical trial

Abstract

- OBJECTIVE: Postoperative pain following shoulder surgery is a devastating sit-uation. Several approaches, including region-al nerve blocks such as combined supras-capular nerve block and axillary nerve block (SSNB+ANB) and peri-articular infiltration (PAI) analgesia, have been investigated to manage postoperative pain. This study aimed to com-pare the effects of PAI and SSNB+ANB on post-operative pain scores and analgesic consump-tion after arthroscopic shoulder surgery. PATIENTS AND METHODS: A single-center prospective, randomized interventional study with a two-arm parallel design was performed. Sixty patients with arthroscopic shoulder sur-gery were randomized to SSNB+ANB (n=30) and PAI (n=30) group. Postoperative pain scores, an-algesic requirements, and complications were evaluated in the postoperative anesthesia recov-ery unit and during the postoperative 24 hours. RESULTS: The age of patients in Group PAI was significantly higher than in Group SSNB+ANB (p<0.001). Groups were similar, considering de-mographic and clinical characteristics (p>0.05). The length of anesthesia and surgery was signifi-cantly longer in Group PAI (p=0.009 and p=0.025). Although there was no significant difference in the amount of change in pain scores for postop-erative 24 hours (p=0.537), postoperative pain scores were significantly higher in Group SSN-B+ANB group than Group PAI during postoper-ative 24 hours except for the 12th-hour evalua-tion (p<0.05). Postoperative opioid requirement and rescue analgesic medications were signifi-cantly higher in Group SSNB+ANB (p<0.001 and p=0.001). The number of postoperative nausea and vomiting attacks was similar (p=0.317). CONCLUSIONS: PAI seems to be a more fea-sible and practical analgesic approach for man-aging postoperative pain after arthroscopic shoulder surgery regarding pain score and cu-mulative analgesic requirement.