Interscalene block versus upper trunk block in shoulder arthroscopy: Randomized comparative study of the ease between...

Interscalene brachial plexus block (ISB) remains the gold standard nerve block in shoulder arthroscopic surgery. However, some anatomical variations exist in addition to several reported complications and technical challenges. Upper trunk block (UTB) may be a feasible alternative. The primary outcome was the success rate of UTB and ISB. Secondary outcomes included: duration of block performance, guidance interventions, visualization of anatomic structures, postoperative pain and opioid consumption, and diaphragmatic function.

One hundred and twenty patients were divided randomly into 2 groups; 60 patients received ISB before general anaesthesia (GA) and 60 patients received UTB before GA. All blocks were performed by anaesthesia trainees under supervision of an attending consultant.

Age, sex, BMI, and duration of surgery were not different statistically. The duration of block performance was significantly longer in the ISB group (P = 0.002). Guidance interventions in the ISB group were higher than the UTB group (P < 0.001). There were no significant differences regarding the worst postoperative pain score (P = 0.574), postoperative nalbuphine consumption (P = 0.813) or success rate (P = 0.31) between groups. Visualization of the anatomic structures in the 2 groups was not statistically significant (P = 0.183). Diaphragmatic function was significantly affected in the ISB group (45% complete paralysis and 35% paresis) versus (8.3% complete paralysis and 30% paresis) in the UTB group.

UTB may be considered a safer and a technically easier approach than ISB for providing equivalent intra and postoperative regional analgesia in arthroscopic shoulder surgery by anaesthesia trainees.