الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 108 |  |  |
| | | from | 108 | | |
Abstract
The incidence of severe intraoperative and postoperative pain following arthroscopic shoulder surgery is severe enough to impair initial healing and rehabilitation. Without the use of high-dose opioids, this pain is difficult to control.
General anesthesia (GA) with regional nerve block may provide better postoperative pain relief than Opioids and avoids complications with high doses of opioids such as nausea, vomiting, drowsiness, and hypoventilation, among other undesirable consequences.
The most popular regional technique is the interscalene brachial plexus block (ISB). This block can occasionally lead to major side effects such as diaphragmatic paralysis, hoarseness of voice, Horner’s syndrome, pneumothorax, and inadvertent paresis of hand muscles that impairs patient satisfaction. Consequently, many patients will need to be admitted to the hospital till regaining baseline hand muscle power.
Most of the superior, medial, and posterior portions of the shoulder joint capsule are supplied with the suprascapular nerve. Additionally, it supplies some branches to the glenoid, acromion, and posterior aspect of the scapula. The suprascapular nerve can provide a safe effective alternative to the interscalene block, with adequate postoperative pain relief after arthroscopic shoulder surgeries with avoiding major side effects related to interscalene nerve block.
The use of ultrasound-guided techniques has many benefits over other methods, including direct visualization of the nerve roots, a reduction in the number of attempts and the total dose of local anesthetic used, and an improvement in the quality of the block.
The purpose of the study is to evaluate the effectiveness of interscalene brachial plexus block (ISB) and selective blockade of suprascapular nerve for postoperative analgesia as well as hand motor power affection following shoulder arthroscopic surgery that was guided by ultrasonography.
This prospective, randomized, comparative investigation took place over the course of a year in the educational hospitals of Ain Shams University.
The main results of the study revealed that:
16(64%) were males, 9(36%) were females in ISB group, while, 17(68%) were males, 8(32%) were females in SSBN, Mean ± SD of age is 41.1±7.3years in ISB, while 40.2±9.4 years in SSNB.
According to the type of surgery in the ISB group, 19 patients underwent rotator cuff repair, 3 patients had bankart operation for shoulder dislocation, 2 patients underwent frozen shoulder adhesiolysis, and 1 patient underwent glenoid cyst excision, While in the SSNB group: 19 patients underwent rotator cuff repair, 4 patients had bankart operations for shoulder dislocation, 1 patient underwent frozen adhesiolysis, and 1 patient underwent shoulder impingement decompression.
The two groups were comparable as regards pain control all over the 24 hours by visual analog score (VAS) at regular intervals (baseline, at PACU,2,4,6,12and 24 hours) at rest and at flexion and there was no statistical difference between them throughout the 24 hours.
SSNB received a larger total narcotic dose (60±26.02) mg of pethidine than ISB (52± 22.73). However, there was no statistical difference between them throughout the 24 hours regarding total narcotic consumption and 1st time for pethidine administration.
In the PACU, the ISB group had a statistically significant reduction in hand power grip strength of 83.684.75%.
Groups were comparable in hand power and there was no statistical difference between them at baseline but there was a statistically significant difference between them as regards hand power immediately, 2, 4, and 6 hours postoperative. However, there was no statistically significant difference in hand power at 12, 24 hours hand power postoperative.
In 2 patients from 25 patients in the interscalene group, saturation decreased to below than 92% on room air, however, saturation increased above 92% with oxygen supply via oxygen mask.
Conclusion
The suprascapular nerve block is a powerful tool to provide postoperative shoulder analgesia in shoulder scope surgeries without affecting hand motor power and avoids patients’ discomfort with hand muscles paresis with interscalene nerve block. Thus, the suprascapular nerve block is a good alternative to interscalene block not only in patients with limited respiratory reserve but also in outpatient shoulderscopic surgeries.