Analgesic benefits and clinical role of the posterior suprascapular nerve block in shoulder surgery: a systematic review, meta-analysis and trial sequential analysis

N Cho, R S Kang, C J L McCartney, A Pawa, I Costache, P Rose, F W Abdallah, N Cho, R S Kang, C J L McCartney, A Pawa, I Costache, P Rose, F W Abdallah

Abstract

The posterior suprascapular nerve block has been proposed as an analgesic alternative for shoulder surgery based on the publication of several comparisons with interscalene block that failed to detect differences in analgesic outcomes. However, quantification of the absolute treatment effect of suprascapular nerve block on its own, in comparison with no block (control), to corroborate the aforementioned conclusions has been lacking. This study examines the absolute analgesic efficacy of suprascapular nerve block compared with control for shoulder surgery. We systematically sought electronic databases for studies comparing suprascapular nerve block with control. The primary outcomes included postoperative 24-h cumulative oral morphine consumption and the difference in area under the curve for 24-h pooled pain scores. Secondary outcomes included the incidence of opioid-related side-effects (postoperative nausea and vomiting) and patient satisfaction. Data were pooled using random-effects modelling. Ten studies (700 patients) were analysed; all studies examined landmark-guided posterior suprascapular nerve block performed in the suprascapular fossa. Suprascapular nerve block was statistically but not clinically superior to control for postoperative 24-h cumulative oral morphine consumption, with a weighted mean difference (99%CI) of 11.41 mg (-21.28 to -1.54; p = 0.003). Suprascapular nerve block was also statistically but not clinically superior to control for area under the curve of pain scores, with a mean difference of 1.01 cm.h. Nonetheless, suprascapular nerve block reduced the odds of postoperative nausea and vomiting and improved patient satisfaction. This review suggests that the landmark-guided posterior suprascapular nerve block does not provide clinically important analgesic benefits for shoulder surgery. Investigation of other interscalene block alternatives is warranted.

Keywords: analgesia; interscalene block; shoulder surgery; suprascapular nerve block; upper extremity nerve blocks.

© 2019 Association of Anaesthetists.

References

    1. Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia 2010; 65: 608-24.
    1. Ritchie ED, Tong D, Chung F, et al. Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality? Anesthesia and Analgesia 1997; 84: 1306-12.
    1. Al-Kaisy A, McGuire G, Chan VW, et al. Analgesic effect of interscalene block using low-dose bupivacaine for outpatient arthroscopic shoulder surgery. Regional Anesthesia and Pain Medicine 1998; 23: 469-73.
    1. Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesthesia and Analgesia 1991; 72: 498-503.
    1. Urmey WF, Gloeggler PJ. Pulmonary function changes during interscalene brachial plexus block: effects of decreasing local anesthetic injection volume. Regional Anesthesia 1993; 18: 244-9.
    1. Price DJ. The shoulder block: a new alternative to interscalene brachial plexus blockade for the control of postoperative shoulder pain. Anaesthesia and Intensive Care 2007; 35: 575.
    1. Rothe C, Steen-Hansen C, Lund J, et al. Ultrasound-guided block of the suprascapular nerve - a volunteer study of a new proximal approach. Acta Anaesthesiologica Scandinavica 2014; 58: 1228-32.
    1. Hussain N, Goldar G, Ragina N, et al. Suprascapular and interscalene nerve block for shoulder surgery: a systematic review and meta-analysis. Anesthesiology 2017; 127: 998-1013.
    1. Auyong DB, Hanson NA, Joseph RS, et al. Comparison of anterior suprascapular, supraclavicular, and interscalene nerve block approaches for major outpatient arthroscopic shoulder surgery: a randomized, double-blind, noninferiority trial. Anesthesiology 2018; 129: 47-57.
    1. Chang K-V, Wu W-T, Hung C-Y, et al. Comparative effectiveness of suprascapular nerve block in the relief of acute post-operative shoulder pain: a systematic review and meta-analysis. Pain Physician 2016; 19: 445-56.
    1. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Journal of Clinical Epidemiology 2009; 62: 1006.
    1. Higgins JPT, Green S, (editors). Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011], 2011. Epub ahead of print 2011. .
    1. Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. British Medical Journal 2011; 343: d5928.
    1. Jovaisas B. Opioids, CPS 2016: Compendium of Pharmaceuticals and Specialties. Ottawa: Canadian Pharmacists Association, 2016.
    1. Farrar JT, Berlin JA, Strom BL. Clinically important changes in acute pain outcome measures: a validation study. Journal of Pain and Symptom Management 2003; 25: 406-11.
    1. Farrar JT, Portenoy RK, Berlin JA, et al. Defining the clinically important difference in pain outcome measures. Pain 2000; 88: 287-94.
    1. Hackworth RJ. A new and simplified approach to target the suprascapular nerve with ultrasound. Journal of Clinical Anesthesia 2013; 25: 347-8.
    1. Price DJ. Axillary (circumflex) nerve block used in association with suprascapular nerve block for the control of pain following total shoulder joint replacement. Regional Anesthesia and Pain Medicine 2008; 33: 280-1.
    1. Price DJ. Combined suprascapular and axillary nerve blockade. Arthroscopy - Journal of Arthroscopic and Related Surgery 2008; 24: 1316-7.
    1. Risdall J. Suprascapular nerve block. New indications and a safer technique. Anaesthesia 1992; 47: 626.
    1. Heron M, Dattani R, Smith R. Interscalene vs suprascapular nerve block for shoulder surgery. British Journal of Hospital Medicine 2016; 77: 494.
    1. Maiettini D. Comparison between ultrasound-guided percutaneous double-needle lavage in the treatment of calcific tendinopathy of the rotator cuffperformed with or without an ultrasoundguided block of the suprascapular nerve. Cardiovascular and Interventional Radiology Conference: Cardiovascular and Interventional Radiological Society of Europe, CIRSE 2017 2017; 40: S122-3.
    1. Kauffman J, Parise C, Weber S. Suprascapular nerve block in rotator cuff surgery: a prospective, randomized study [abstract], 2007. American Academy of Orthopaedic Surgeons Annual Meeting; 2007 Feb 14-18; San Diego (CA). .
    1. Karovic D, Blumenthal S, Schneeberger A, et al. Suprascapular nerve block prolongs analgesia after nonarthroscopic shoulder surgery but does not improve outcome: suprascapular nerve blocked one, two..or more times? Anesthesia and Analgesia 2003; 97: 1195.
    1. Park JK, Lee YB, Kim SY. Postoperative pain relief effect of a suprascapular nerve block before arthroscopic shoulder surgery. Anesthesia and Pain Medicine 2012; 7: 8-11.
    1. Shin YD, Han JS. The effect of sono-guided brachial plexus block on postoperative pain control for arthroscopic shoulder surgery: comparison with general anesthesia. Anesthesiology and Pain Medicine 2010; 5: 183-6.
    1. Jeske HC, Kralinger F, Wambacher M, et al. A randomized study of the effectiveness of suprascapular nerve block in patient satisfaction and outcome after arthroscopic subacromial decompression. Arthroscopy - Journal of Arthroscopic and Related Surgery 2011; 27: 1323-8.
    1. Lee SM, Park SE, Nam YS, et al. Analgesic effectiveness of nerve block in shoulder arthroscopy: comparison between interscalene, suprascapular and axillary nerve blocks. Knee Surgery, Sports Traumatology, Arthroscopy 2012; 20: 2573-8.
    1. Lee JJ, Yoo YS, Hwang JT, et al. Efficacy of direct arthroscopy-guided suprascapular nerve block after arthroscopic rotator cuff repair: a prospective randomized study. Knee Surgery, Sports Traumatology, Arthroscopy 2015; 23: 562-6.
    1. Singelyn FJ, Lhotel L, Fabre B. Pain relief after arthroscopic shoulder surgery: a comparison of intraarticular analgesia, suprascapular nerve block, and interscalene brachial plexus block. Anesthesia and Analgesia 2004; 99: 589-92.
    1. Nam YS, Jeong JJ, Han SH, et al. An anatomic and clinical study of the suprascapular and axillary nerve blocks for shoulder arthroscopy. Journal of Shoulder and Elbow Surgery 2011; 20: 1061-8.
    1. Jerosch J, Saad M, Greig M, et al. Suprascapular nerve block as a method of preemptive pain control in shoulder surgery. Knee Surgery, Sports Traumatology, Arthroscopy 2008; 16: 602-7.
    1. Park JY, Bang JY, Oh KS. Blind suprascapular and axillary nerve block for post-operative pain in arthroscopic rotator cuff surgery. Knee Surgery, Sports Traumatology, Arthroscopy 2016; 24: 3877-83.
    1. Abdallah FW, Halpern SH, Aoyama K, et al. Will the real benefits of single-shot interscalene block please stand up? A systematic review and meta-analysis. Anesthesia and Analgesia 2015; 120: 1114-29.
    1. Chan C, Peng PWH. Suprascapular nerve block: a narrative review. Regional Anesthesia and Pain Medicine 2011; 36: 358-73.
    1. Tran J, Peng PWH, Agur AMR. Anatomical study of the innervation of glenohumeral and acromioclavicular joint capsules: implications for image-guided intervention. Regional Anesthesia and Pain Medicine 2019; .
    1. El-Boghdadly K, Chin KJ, Chan VWS. Phrenic nerve palsy and regional anesthesia for shoulder surgery: anatomical, physiologic, and clinical considerations. Anesthesiology 2017; 127: 173-91.
    1. Holmberg A, Sauter AR, Klaastad Ø, et al. Pre-operative brachial plexus block compared with an identical block performed at the end of surgery: a prospective, double-blind, randomised clinical trial. Anaesthesia 2017; 72: 967-77.
    1. Hewson DW, Bedforth NM, Hardman JG. Peripheral nerve injury arising in anaesthesia practice. Anaesthesia 2018; 73: 51-60.
    1. Wiegel M, Moriggl B, Schwarzkopf P, et al. Anterior suprascapular nerve block versus interscalene brachial plexus block for shoulder surgery in the outpatient setting a randomized controlled patient- and assessor-blinded trial. Regional Anesthesia and Pain Medicine 2017; 42: 310-8.
    1. Price D. Novel ultrasound-guided suprascapular nerve block. Regional Anesthesia and Pain Medicine 2012; 37: 676-7.

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