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Randomized comparison between interscalene and costoclavicular blocks for arthroscopic shoulder surgery
Julián Aliste1, Daniela Bravo2, Sebastián Layera2
1Department of Anesthesia, Hospital Clínico Universidad de Chile, University of Chile, Santiago, Chile julian.aliste@uchile.cl.
Regional Anesthesia and Pain Medicine
|January 13, 2019
Summary
Costoclavicular brachial plexus block (CCB) offers pain relief comparable to interscalene block (ISB) for shoulder surgery. CCB avoids the risk of hemidiaphragmatic paralysis associated with ISB, making it a potentially safer alternative.
Area of Science:
- Anesthesiology
- Regional Anesthesia
- Musculoskeletal Surgery
Background:
- Ultrasound-guided interscalene block (ISB) and costoclavicular brachial plexus block (CCB) are used for arthroscopic shoulder surgery.
- ISB is associated with a high incidence of hemidiaphragmatic paralysis.
Purpose of the Study:
- To compare the efficacy and safety of ultrasound-guided CCB versus ISB for arthroscopic shoulder surgery.
- To determine if CCB provides equivalent postoperative analgesia to ISB without causing hemidiaphragmatic paralysis.
Main Methods:
- A randomized trial involving 44 patients undergoing arthroscopic shoulder surgery.
- Patients received either an ultrasound-guided ISB or CCB with identical local anesthetic and adjuncts.
- Block efficacy was assessed using a composite scale, and hemidiaphragmatic paralysis was evaluated via ultrasonography.
Main Results:
- Both ISB and CCB groups achieved equivalent postoperative pain scores and patient satisfaction.
- ISB demonstrated a significantly higher incidence of hemidiaphragmatic paralysis (100%) compared to CCB (0%).
- CCB had a longer onset time but comparable block success rates and opioid consumption to ISB.
Conclusions:
- Ultrasound-guided CCB provides effective postoperative analgesia for arthroscopic shoulder surgery, similar to ISB.
- CCB circumvents the risk of hemidiaphragmatic paralysis, presenting a safer alternative to ISB.
- Further research is needed to confirm CCB's efficacy for surgical anesthesia in these procedures.
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