الفهرس 
SHOULDER JOINT ANATOMYOnly 14 pages are availabe for public view
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Abstract
S
evere intraoperative and postoperative pain associated with arthroscopic shoulder surgery has a high incidence reaching up to 45%; it is often significant enough to interfere with initial recovery and rehabilitation. This pain is difficult to manage without large doses of opioids.
Opioids have many adverse effects including nausea, vomiting, sedation, and/or failure to control pain. Adding regional nerve block to general anesthesia (GA) may improve the quality of postoperative pain relief. Interscalene nerve block (ISNB) is the most commonly used approach, as it provides effective postoperative analgesia for 6 to 12 hours.
This block is associated with infrequent but potentially serious complications such as diaphragmatic paralysis, hoarseness of voice, Horner’s syndrome, and pneumothorax. These may be because of inadvertent injection of local anesthetic into the cerebrospinal fluid, the epidural space, or the vertebral artery. Its associated side effects are more common because of the unpredictable spread of local anesthetic to important adjacent structures such as the phrenic and vagus nerves and the stellate ganglion.
The suprascapular nerve supplies sensation for most of the posterior, medial, and superior parts of the shoulder joint capsule. It also supplies the supraspinatus and infraspinatus muscles of the rotator cuff and some branches to the teres minor, the glenoid, the acromion, and the posterior surface of the scapula.
Combined suprascapular nerve and Intra-articular injection (SSNB+IAI) can provide a safe effective alternative to the interscalene block, with adequate postoperative pain relief after arthroscopic shoulder surgeries and with viable diaphragmatic sparing.
Using ultrasound-guided brachial plexus block has many advantages over other techniques as it allows direct visualization of the nerve roots, decreases the number of attempts, decreases the total dose of the used local anesthetic, improves the quality of the block, and allows for faster onset with longer duration of the block.
The study is aimed to compare Interscalene nerve block ISNB with the suprascapular nerve and Intra-articular injection (SSNB+IAI) for postoperative analgesia after shoulder arthroscopic surgery guided with ultrasound.
This is a prospective, randomized, double-blinded study, that was carried out in Ain Shams University Educational Hospitals, through a period of six months.
The main results of the study revealed that:
• 27 (90%) were male, 3 (10%) were female, mean ± SD of age is 37.32 ± 10.13 years, mean ± SD of weight is 77.40 ± 11.07 Kg.
• The pain threshold score using VAS score at different times postoperatively showed a non-significant difference between the ISNB and SSNB groups at all times, with p-values at 0.071, 0.28, 0.378, 0.358, 0.451 for VAS 2, 4, 8, 16, 24 hours respectively except at VAS 0 hour a significant difference at p-value of 0.029 was found but still the VAS score was less than 4. Surprisingly a reported improvement in the expression of postoperative pain was noticed later on. This may be due to the very dense block offered by interscalene brachial plexus block unlike the suprascapular nerve block combined with intra-articular injection.
• there is a non-significant difference in the total number of patients who needed analgesics postoperatively in the two different groups, with a total of 4 out of 15 patients in the ISNB group and 7 patients out of 15 in the SSNB+IAI group, with a p-value of 0.239.
• there is non-significant difference between the two groups in the time of 1st analgesic with a p-value of 0.941.
• Also, the total dose of pethidine consumed in 24 hours is also non-significant between the two groups with p-value 0.865.
• So, the ISNB and SSNB+IAI have the same efficacy for postoperative analgesia after shoulder arthroscopy done for different purposes.
• A non-significant difference in patient satisfaction assessed 24-hour post-operative, with p-value 0.054.
• There is a significant difference between the two groups regarding the reported complications, with a p-value of 0.017.
• Highly significant difference between the two groups regarding phrenic nerve paresis which is assessed using diaphragmatic ultrasound, with a p-value of 0.000.
• Based on our results we recommend further studies on larger patients and longer periods of follow-up to emphasize our conclusion.