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Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery: A Multicenter
Faraj W Abdallah1, Duminda N Wijeysundera, Andreas Laupacis
1From the Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada (F.W.A.) the Department of Anesthesia (F.W.A., D.N.W., R.B., A.M., V.W.S.C.) the Institute of Health Policy, Management, and Evaluation (D.N.W., A.L.) the Department of Medicine (A.L.) the Dalla Lana School of Public Health (K.E.T.), University of Toronto, Toronto, Canada the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Canada (F.W.A., D.N.W., A.L.) the Department of Anesthesia (D.N.W.) the Department of Medicine (A.L.), St. Michael's Hospital, Toronto, Canada the Department of Anesthesia and Pain Management, University Health Network, Toronto, Canada (D.N.W., V.W.S.C.) the Department of Anesthesia, Women's College Hospital, Toronto, Canada (R.B.) the Department of Anesthesia, North York General Hospital, Toronto, Canada (A.M.) the Department of Anesthesia, Wexner Medical Center, Ohio State University, Columbus, Ohio (N.H.) the Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada (K.E.T.).
Anterior suprascapular block is a safe and effective alternative to interscalene block for shoulder surgery pain control. This study found suprascapular block noninferior to interscalene block for postoperative pain management and superior trunk blockade.
Area of Science:
- Anesthesiology
- Regional Anesthesia
- Pain Management
Background:
- Interscalene brachial plexus block is standard for shoulder surgery but carries risks.
- Anterior suprascapular block is a potential alternative with limited comparative data.
- This study investigated the noninferiority of anterior suprascapular block versus interscalene block for postoperative pain control.
Purpose of the Study:
- To test the hypothesis that anterior suprascapular block is noninferior to interscalene block for shoulder surgery pain relief.
- To evaluate the success of superior trunk (C5-C6 dermatomes) blockade with suprascapular block as a secondary objective.
Main Methods:
- A multicenter, double-blind, noninferiority randomized trial involving 140 patients undergoing shoulder surgery.
- Patients received either interscalene or anterior suprascapular block with ropivacaine and epinephrine.
- Primary outcome: area under the curve of postoperative visual analog scale pain scores over 24 hours.
Main Results:
- The anterior suprascapular block was found to be noninferior to the interscalene block (mean difference -0.3 U; 90% CI -0.8 to 0.12).
- Superior trunk blockade success rates were similar between groups (risk ratio 0.98; 95% CI 0.92 to 1.01).
- Other analgesic outcomes showed no clinically significant differences.
Conclusions:
- Anterior suprascapular block is noninferior to interscalene block for postoperative pain control after shoulder surgery.
- Suprascapular block consistently achieves superior trunk blockade, supporting its use as an alternative.
- This technique offers a viable alternative to interscalene block with comparable efficacy.
