Comparison of postoperative analgesic efficacy between the costoclavicular with superficial cervical plexus block combination and subomohyoid plane block in patients undergoing arthroscopic shoulder surgery

Objective: Arthroscopic shoulder surgery is an orthopedic surgical procedure performed to relieve pain and movement restriction caused by shoulder pathologies such as rotator cuff tears and recurrent shoulder dislocations. This surgical procedure is usually associated with severe postoperative pain. Peripheral nerve blocks, which are a part of multimodal analgesia, are an effective method that reduces opioid consumption in the management of postoperative pain. The interscalene block (İSB) is a regional technique commonly used in shoulder surgery and is considered the gold standard. However, the risk of phrenic nerve blockade and associated hemidiaphragm paralysis is high in ISB, which can lead to serious respiratory complications. Therefore, over time, diaphragm-sparing block techniques have been developed. Examples of these techniques include the subomohyoid plane (SOP) block, costoclavicular (CC) block, and superficial cervical (SC) block. In this study, we aimed to compare the postoperative analgesic efficacies of SOP block and CC+SC block combination in patients undergoing arthroscopic shoulder surgery under general anesthesia. Methods: This study was conducted prospectively, randomized and double-blind at Samsun University Samsun Training and Research Hospital between January 2023 and May 2024. Patients aged between 18 and 75 years, classified as American Society of Anesthesiologists (ASA) class I, II or III, who were scheduled for unilateral arthroscopic shoulder surgery under general anesthesia were included in the study. Patients were randomized into two groups as SOP and CC+SC. Blocks were performed under ultrasound guidance before surgery and patients were monitored for 24 hours after surgery. Our primary endpoint was the 24-hour cumulative morphine consumption. Secondary outcomes included postoperative pain scores at 1, 3, 6, 12, 18, and 24 hours, time to first analgesic request, presence of motor block and hemidiaphragm paralysis, incidence of nausea and vomiting, and QoR-15 survey results. Results: A total of 61 patients, 28 female and 33 male, were included in the study. (Group SOP: 31, Group KK+YS: 30). Postoperative 24-hour cumulative morphine consumption was found to be 4.10±3.06 mg on average in the SOP group and 3.60±3.10 mg in the KK+YS group, with no statistically significant difference between the two groups at any time frame (p>0.05). NRS scores at rest and with movement were similar between the groups. The time of first analgesia request and the number of patients developing motor block were significantly higher in the KK+YS group (p<0.05). Hemidiaphragm paralysis was not detected in any patient. Nausea-vomiting and QoR-15 questionnaire results were found to be similar between the two groups. Conclusions: In this study, it was shown that there was no difference between SOP block and KK+YS block in patients undergoing arthroscopic shoulder surgery postoperatively analgesic requirements and pain scores. However, the first analgesic request time was longer in the KK+YS group. This result may provide insight regarding the duration of the block effect. Although the findings show that both techniques are effective and applicable in pain management after arthroscopic shoulder surgery, randomized controlled studies comparing block techniques performed with different volumes and concentrations are needed.