Postoperative pain control after arthroscopic rotator cuff repair: Arthroscopy-guided continuous suprascapular nerve block versus ultrasound-guided continuous inter-scalene block

Purpose: We aimed to compare the clinical efficacy and safety of arthroscopy-guided continuous suprascapular nerve block (AS-SSNB) and ultrasound-guided continuous interscalene block (US-ISB) in postoperative analgesia in patients undergoing arthroscopic rotator cuff repair (ARCR).

Methods: A prospective study was performed between March and November 2020. In total, 76 patients were enrolled and divided into two groups: in 38 patients of group 1 (AS-SSNB), an indwelling catheter was introduced via the Neviaser portal under arthroscopic view before closing the portal at the end of the surgery; and in 38 patients of group 2 (US-ISB), an indwelling catheter was inserted directing towards the interscalene brachial plexus prior to the surgery under ultrasound-guidance. The primary outcome was the pain score measured by the visual analog scale (VAS) at postoperative 24 hours during admission. Comparisons were conducted at different time points (postoperative 4, 8, 24, and 48 hours). The secondary outcome was any of the following events: neurologic complications such as sensory/motor change in the upper extremities, hemi-diaphragmatic paresis, dyspnea, dysphonia, and Horner’s syndrome. Opioid usage until postoperative 3 weeks was compared between the groups.

Results: The VAS scores in groups 1 and 2 were comparable at each postoperative time point (ANOVA, p = 0.919; trends, p = 0.132). Neurological deficits were more common in group 2 than in group 1 (8 vs. 32 patients, p < 0.001). Decreased excursion of the diaphragm was more common in group 2 (partial or complete paresis of the hemi-diaphragm: 1 vs. 29 patients, p-value < 0.001). Opioid consumption was similar in both groups (morphine milligram equivalents per kilogram; 1.75 vs 1.55, p = 0.195).

Conclusions: Our findings show that AS-SSNB is not inferior to US-ISB for postoperative pain control following ARCR while showing fewer temporary neurologic complications.

Keywords: arthroscopic rotator cuff repair; interscalene block; rotator cuff tear; suprascapular nerve block.