Suprascapular nerve block and axillary nerve block versus interscalene nerve block for arthroscopic shoulder surgery: A meta-analysis of randomized controlled trials

Changjiao Sun, Xiaofei Zhang, Xiaolin Ji, Peng Yu, Xu Cai, Huadong Yang, Changjiao Sun, Xiaofei Zhang, Xiaolin Ji, Peng Yu, Xu Cai, Huadong Yang

Abstract

Background: The interscalene brachial plexus block (ISB) is a commonly used nerve block technique for postoperative analgesia in patients undergoing shoulder arthroscopy surgery; however, it is associated with potentially serious complications. The use of suprascapular nerve block (SSNB) and axillary Nerve Block (ANB) has been reported as an alternative nerve block with fewer reported side effects for shoulder arthroscopy. This review aimed to compare the impact of SSNB and ANB with ISB during shoulder arthroscopy surgery.

Methods: A meta-analysis was conducted to identify relevant randomized or quasirandomized controlled trials involving SSNB and ISB during shoulder arthroscopy surgery. We searched Web of Science, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CNKI, and Wanfang database from 2010 through August 2021.

Results: We identified 641 patients assessed in 10 randomized or quasirandomized controlled trials. Compared with the ISB group, the SSNB+ANB group had higher visual analog scale or numerical rating scale in PACU (P = .03), 4 hour (P = .001),6 hour after the operation (P = .002), and lower incidence of complications such as Numb/Tingling (P = .001), Weakness (P <.00001), Horner syndrome (P = .001) and Subjective dyspnea (P = .002). No significant difference was found for visual analog scale or numerical rating scale 8 hour (P = .71),12 hour (P = .17), 16 hour (P = .38),1day after operation (P = .11), patient satisfaction (P = .38) and incidence of complications such as hoarseness (P = .07) and nausea/vomiting (P = .41) between 2 groups.

Conclusion: Our high-level evidence has established SSNB+ ANB as an effective and safe analgesic technique and a clinically attractive alternative to interscalene block during arthroscopic shoulder surgery, especially for severe chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity. Given our meta-analysis's relevant possible biases, we required more adequately powered and better-designed randomized controlled trial studies with long-term follow-up to reach a firmer conclusion.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1
Figure 1
The search results and selection procedure. The literature search identified 386 citations. Of these, we removed 305 duplicates. After reviewing the 81 remaining articles’ titles and abstracts, we excluded 61 papers according to the inclusion and exclusion criteria; 20 full texts were retrieved. Because some articles didn’t compare the SSBN+ANB with Block ISB, we excluded ten studies. Finally, we identified 641 patients assessed in 10 articles.
Figure 2
Figure 2
Risk of bias summary for included studies. ? = bias unknown. + = no bias, - = bias. Nine studies adequately described the correct randomization. Nine studies demonstrated sufficient allocation concealment. Six studies described the blinding of participants and personnel. All ten articles described the blinding of outcome assessment and avoided selective reporting. Nine articles retained complete outcome data. We rated as unclear risk of other bias because we can’t ignore other potential dangers of biases. As a result, the risk of bias is low or moderate in most of the articles reviewed.
Figure 3
Figure 3
The risk of bias graph. The overall quality of the included studies was considered adequate
Figure 4
Figure 4
A forest plot diagram showing VAS or NRS The pooled results showed that ISB group had lower VAS or NRS in PACU (MD = 1.38, 95% CI [0.16,2.60], P = .03),4 h after operation (MD = 1.78, 95% CI [0.72,2.85], P = .001). and 6 h after operation (MD = 1.08, 95% CI [0.40, 1.76], P = .002). No significant difference was found for VAS or NRS 8 h after operation(MD = 0.3, 95% CI [-1.28,1.88], P = .71),12 h (MD = -0.51, 95% CI [-1.23,0.21], P = .17), 16 h (MD = -0.75, 95% CI [-2.4,0.91], P = .38)and 1d after operation((MD = -0.5, 95% CI [-1.13,0.12], P = .11) between two groups.
Figure 5
Figure 5
A forest plot diagram showing Block related complications. The pooled data showed that SSNB+ ANB group had lower incidence of numb/tingling (RR = 0.29, 95% CI [0.13,0.61], P = .001), weakness (RR = 0.11, 95% CI [0.05,0.24], P <.0001), Horner syndrome (RR = 0.09, 95% CI [0.02,0.37], P = .001) and Subjective dyspnea (RR = 0.19, 95% CI [0.07,0.55], P = .002). No significant difference was found for Hoarseness (RR = 0.26, 95% CI [0.06,1.12], P = .07), and nausea/vomiting (RR = 0.8, 95% CI [0.47,1.36], P = .41).
Figure 6
Figure 6
A forest plot diagram showing patient satisfaction. We didn’t find any significant difference for patient satisfaction MD = 0.31, 95% CI [-0.38,0.99], P = .38).

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