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Nerve Blocks for Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials With a Network
Eoghan T Hurley1, Daniel E Goltz2, Rachel M Frank3
1Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.
The American Journal of Sports Medicine
|July 25, 2026
Summary
Interscalene block (ISB) is most effective for reducing opioid use after shoulder arthroscopy. Combined techniques like supraclavicular block with axillary nerve block offer superior early pain control.
Area of Science:
- Anesthesiology
- Orthopedic Surgery
- Pain Management
Background:
- Shoulder arthroscopy, though minimally invasive, causes significant postoperative pain.
- Pain peaks within 24 hours, impacting rehabilitation and patient satisfaction.
Purpose of the Study:
- To compare analgesic efficacy of various nerve blocks and general anesthesia for shoulder arthroscopy.
- Utilized a network meta-analysis of randomized controlled trials.
Main Methods:
- Systematic review and meta-analysis of 63 RCTs (4235 patients).
- Compared interscalene block (ISB), suprascapular block (SSB), supraclavicular block (SCB), combined blocks, and general anesthesia (GA).
- Analyzed postoperative pain scores and 24-hour opioid consumption using random-effects models and ranking (P-scores, SUCRA).
Main Results:
- ISB consistently reduced 24-hour opioid consumption (SUCRA 77.5%).
- Combined blocks showed superior early pain control: SCB+Ax at 2 hours (SUCRA 73.5%), SSB+CCB at 6 hours (SUCRA 72.8%).
- SSB alone was effective at 12 hours (SUCRA 85.1%), and SCB+Ax at 24 hours.
Conclusions:
- ISB is the most reliable for reducing postoperative opioid needs in shoulder arthroscopy.
- SSB alone and combined blocks (SCB+Ax, SSB+CCB) offer enhanced early to intermediate pain management.