Assessment of our regional anesthesia applications in arthroscopic shoulder surgery

Interscalene brachial plexus block (ISB) is currently the gold standard for postoperative pain relief in patients undergoing shoulder surgery. But it is associated with a wide spectrum of block related complications, with the risk of hemidiaphragmatic paresis of prominent interest. In our thesis, we evaluated postoperative analgesia and hemidiaphragmatic function for blocks at the anterior suprascapular and anterior costoclavicular levels alternative to the interscalene block, and compared three of them with each other. Forty-six patients scheduled for shoulder arthroscopy were included in this prospective observer blinded study and received either ISB (n = 15), anterior suprascapular block(ASB) (n = 15), or costoclavicular brachial plexus block (CCB) (n = 16). Primary aims for this study were to document postoperative numeric rating scale (NRS) pain score at 1, 2, 6, 12, and 24 hours and assesment of diaphragmatic excursion at the beginings and 30 min after the blocks. Surgery was performed under general anaesthesia. NRS scores at first two hours were statistically lower in the ISB group than in other two groups (p<0,001), with no clinical significance. At 6h the was no statistically significant difference at NRS scores between three groups. NRS scores at 12h and 24h were statistically lower in the ASB group than ISB group (p<0,05), and there were not statistically significant difference between ASB and CCB groups (p>0,05). Ipsilateral diaphragmatic excursion at 30 min was best preserved in CCB group with statistically significant difference than other groups (p<0,001). In ASB group diaphragmatic excursion were also statistically significantly better than ISB group (p<0,001). Compared with the ISB, the ASB and CCB provides satisfactory postoperative analgesia while preserving diaphragmatic function(with less impact on pulmonary function). These blocks may therefore be considered an alternative to traditional ISB for shoulder arthroscopy.