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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.
Background:
Despite the minimally invasive nature of shoulder arthroscopy, postoperative pain can be substantial, often peaking within the first 24 hours and significantly influencing early rehabilitation, patient satisfaction, and overall outcomes.
Purpose:
To compare the analgesic efficacy of interscalene block (ISB), suprascapular block (SSB), supraclavicular block (SCB), combined block techniques, and general anesthesia (GA) alone for shoulder arthroscopy using a network meta-analysis (NMA) of randomized controlled trials (RCTs).
Study Design:
Systematic review and meta-analysis; Level of evidence, 1.
Methods:
A systematic review of the literature was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they were an RCT evaluating ISB, SSB, SCB, combined block techniques, and GA. Outcomes included postoperative pain scores in the postanesthesia care unit and at 2, 6, 12, and 24 hours, as well as 24-hour opioid consumption. Mean differences with 95% confidence intervals were synthesized using a random-effects model with a common between-study variance. Treatments were ranked using P-scores and expressed as surface under the cumulative ranking curve (SUCRA) values.
Results:
A total of 63 RCTs (4235 patients) were included. ISB consistently reduced 24-hour opioid consumption compared with other techniques (P-score = 0.775; SUCRA = 77.5%). Combined strategies demonstrated superior pain control at specific postoperative time points: SCB plus axillary nerve block (Ax) ranked highest at 2 hours (P-score = 0.735), SSB plus costoclavicular block (CCB) at 6 hours (P-score = 0.728), and SSB alone at 12 hours (P-score = 0.851). At 24 hours, SCB+Ax again ranked highest (P-score = 0.638), although differences from ISB were modest. Between-study variance (τ2) was moderate for pain outcomes (range, 0.85-7.93) and substantial for opioid consumption (τ2 = 28.16).
Conclusion:
ISB remains the most consistent technique for reducing postoperative opioid requirements after shoulder arthroscopy. Alternative strategies, including SSB alone as well as combined block approaches (eg, SCB+Ax, SSB+CCB), demonstrated incremental benefits in pain control during the early and intermediate postoperative periods.