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Comparison of anterior suprascapular, supraclavicular, and interscalene nerve block approaches for major outpatient arthroscopic shoulder surgery: a randomized, double-blind, noninferiority trial - 12/7/2018

Anesthesiology 2018; 129: 47-57


These authors carried out a non-inferiority study evaluating analgesia for blocks at the supraclavicular and anterior suprascapular levels, comparing them individually with the interscalene approach.


A total of 189 subjects undergoing arthroscopic shoulder surgery were recruited to this double-blind trial and randomised to interscalene, supraclavicular or anterior suprascapular block using 15?ml, 0.5% ropivacaine. The primary outcome was numerical rating scale pain scores, analysed using non-inferiority testing. The predefined non-inferiority margin was 1 point on the 11-point pain scale. Secondary outcomes included opioid consumption and pulmonary assessments.


 All subjects completed the study through the primary outcome analysis. Mean pain after surgery was: interscalene = 1.9 (95% confidence interval [CI] 1.3 to 2.5), supraclavicular = 2.3 (1.7 to 2.9) and suprascapular = 2.0 (1.4 to 2.6). The primary outcome, mean pain score difference of supraclavicular-interscalene, was 0.4 (-0.4 to 1.2; p=0.088 for non-inferiority) and of suprascapular-interscalene was 0.1 (–0.7 to 0.9; p=0.012 for non-inferiority). Secondary outcomes showed similar opioid consumption, with better preservation of vital capacity in the anterior suprascapular group (90% baseline [p<0.001]) and the supraclavicular group (76% [p=0.002]) when compared with the interscalene group (67%).


The authors conclude that the anterior suprascapular block, but not the supraclavicular, provides non-inferior analgesia compared with the interscalene approach for major arthroscopic shoulder surgery. They advise that pulmonary function is best preserved with the anterior suprascapular nerve block.

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