Analgesic Efficacy of Suprascapular Nerve Block versus Combined Suprascapular and Axillary Nerve Block in Patients Undergoing Shoulder Arthroscopy: A Prospective, Randomized, Comparative Study

Abstract

Abstract Background: Immediate post-operative pain can be severe and is an important outcome measure for patients in shoulder arthroscopic surgeries. Interscalene block is the most widely used and studied technique for post shoulder arthroscopy pain relief and is associated with certain unpleasant adverse effects. Suprascapular nerve block (SSNB) has been suggested as an alternative and safer block. As the suprascapular nerve contributes to 70% of the sensory nerve supply to the shoulder joint, and the axillary circumflex nerve is the other major nerve contributing to 25%; therefore, a combined block of these two nerves should provide more effective pain relief than SSNB alone. Aim: This study aimed to compare the efficacy of combined SSNB and axillary nerve block (ANB) with SSNB alone for analgesia after shoulder arthroscopy in terms of level of pain scores, total analgesic consumption, and patient satisfaction in 24 h. Methods: Forty-one patients posted for shoulder arthroscopy were randomly allocated into two groups, Group S (n = 20) receiving SSNB and Group C (n = 21) receiving combined SSNB and ANB. Visual Analog Scale (VAS) both at rest and during movement at 1, 3, 6, 12, 24 h, and at the time of first demand, total consumption of analgesics in 24 h and patient satisfaction score at 12 and 24 h were noted. Statistical Analysis: The data was analyzed by Student’s t-test, Mann-Whitney U test, and Fisher’s exact test using Graph Pad PRISM 9, a p<0.05 was considered significant. Results: The VAS scores both at rest and during movement were significantly less in Group C at 1, 6, 12 h, and at the time of the first demand of analgesic (p<0.05). Compared to Group S, Group C had a longer pain-free duration (154.3 ± 11.41 min vs. 36.60 ± 6.553 min; P < 0.001) and lesser cumulative consumption of pethidine (300.0 ± 8.894 mg vs. 336.8 ± 13.27 mg; P = 0.0256). The satisfaction level was better in Group C at 12 h (P = 0.002) but comparable to the Group S at 24 h (P = 0.0673). Conclusion: Combined SSNB and ANB provided better pain relief in first 12 h, better patient satisfaction in the first 12 h and decreased overall consumption of analgesics in the first 24 h compared to SSNB alone.