Combined suprascapular nerve block and axillary nerve block approach vs. peri-articular infiltration analgesia for postoperative pain management following arthroscopic shoulder surgery: a randomized clinical trial.

Objective: Postoperative pain following shoulder surgery is a devastating situation. Several approaches, including regional nerve blocks such as combined suprascapular nerve block and axillary nerve block (SSNB+ANB) and peri-articular infiltration (PAI) analgesia, have been investigated to manage postoperative pain. This study aimed to compare the effects of PAI and SSNB+ANB on postoperative pain scores and analgesic consumption after arthroscopic shoulder surgery.

Patients And Methods: A single-center prospective, randomized interventional study with a two-arm parallel design was performed. Sixty patients with arthroscopic shoulder surgery were randomized to SSNB+ANB (n=30) and PAI (n=30) group. Postoperative pain scores, analgesic requirements, and complications were evaluated in the postoperative anesthesia recovery unit and during the postoperative 24 hours.

Results: The age of patients in Group PAI was significantly higher than in Group SSNB+ANB (p<0.001). Groups were similar, considering demographic and clinical characteristics (p>0.05). The length of anesthesia and surgery was significantly longer in Group PAI (p=0.009 and p=0.025). Although there was no significant difference in the amount of change in pain scores for postoperative 24 hours (p=0.537), postoperative pain scores were significantly higher in Group SSNB+ANB group than Group PAI during postoperative 24 hours except for the 12th-hour evaluation (p<0.05). Postoperative opioid requirement and rescue analgesic medications were significantly higher in Group SSNB+ANB (p<0.001 and p=0.001). The number of postoperative nausea and vomiting attacks was similar (p=0.317).

Conclusions: PAI seems to be a more feasible and practical analgesic approach for managing postoperative pain after arthroscopic shoulder surgery regarding pain score and cumulative analgesic requirement.