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Comparison between infraspinatus-Teres minor (ITM) Interfascial block and superior trunk block in shoulder
1School of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Study Objective:
To evaluate whether there are differences in postoperative pain scores and the incidence of hemidiaphragmatic paralysis (HDP) between ultrasound-guided superior trunk block (STB) and infraspinatus teres minor fascial plane block (ITM).
Design:
Prospective, randomized controlled non-inferiority trial.
Setting:
A tertiary hospital.
Patients:
A total of 100 patients aged 18 to 65 years scheduled for elective arthroscopic surgery were enrolled.
Interventions:
Following sterile skin preparation, patients in the STB group received 15 mL of 0.375 % ropivacaine, while those in the ITM group received 25 mL of 0.375 % ropivacaine.
Measurements:
The primary outcome was the highest resting pain score during the first 24 h postoperatively. Secondary outcomes included resting pain scores at six predefined time points (1, 3, 6, 9, 12,and 24 h), the incidence and severity of hemidiaphragmatic paralysis (HDP), block performance time, sensory block onset time, duration of analgesia, postoperative rescue analgesic consumption, grip strength, patient satisfaction scores, 24-h Quality of Recovery-15 (QoR-15) assessments, and Overall Benefit of Analgesia Scores (OBAS).
Main Results:
Within 24 h postoperation, the highest pain score was 3 [2.0-4.0] in the STB group and 3 [2.8 to 4.3] in the ITM group, with a median difference of 0 (95 % CI, -1 to 0). The upper limit of the 95 % CI was below the prespecified non-inferiority margin of 1″. (non-inferiority P < 0.01).
Conclusions:
For maximal postoperative pain control within 24 h after shoulder arthroscopy, the ITM block was noninferior to STB, with significantly reduced diaphragmatic paralysis rates.
