Efficacy Of Direct Arthroscopy-guided Suprascapular Nerve Block Under Shoulder Arthroscopy In Postoperative Analgesia Of Rotator Cuff Repair

Objective : To compare the results of arthroscopy-guided suprascapular nerve block(SSNB)with those of ultrasound-guided interscalene brachial plexus block(ISB)in terms of postoperative pain and satisfaction with in the first 48 hours after arthroscopic supraspinatus and/or infraspinatus tendon repair.Methods:A randomized,controlled trial was used in this study.60 patients underwent arthroscopic supraspinatus and/or infraspinatus tendon repair from Northern Jiangsu People's Hospital from April to August 2018 were randomly allocated to either of the following two groups: group SSNB(n =30)arthroscopy-guided SSNB was performed by injection of 20 ml of 0.5% ropivacaine followed general anesthesia;group ISB(n=30): ultrasound-guided ISB was performed by preoperative injection of 20 ml of 0.5%ropivacaine followed general anesthesia.Visual analog score(VAS)at rest and on movement at 2,4,8,12,24 and 48 h after surgery,dosage of nonsteroidal anti-inflammatory drugs and opioid analgesics,incidence of postoperative adverse reactions,and analgesic satisfaction at 48 h after surgery were compared between the two groups.Results: The general preoperative data of the two groups included age,gender,VAS score,American shoulder and elbow surgery(ASES)score,body mass index,etc,was no significant difference(P> 0.05).There was no significant difference in rotator cuff injury site,rotator cuff tear size and operation time between groups(P> 0.05).The test VAS score at rest between the SSNB group and ISB group at 2 h,4 h,8 h,12 h,24 h and 48 h after surgery were 1(0.8,1.3),1(1.0,2.0);1(1.0,2.0),2(1.0,3.0);3(2.0,4.0),4.5(2.0,5.3);3(2.0,4.0),4.5(3.0,6.0);3(2.0,3.0),3(2.0,4.0);2(1.8,3.0),2.5(2.5,3.0).The VAS score on movement between the SSNB group and ISB group at 2 h,4 h,8 h,12 h,24 h and 48 h after surgery were 3(3.0,4.0),3.5(3.0,4.3);4(4.0,5.0),5(4.0,6.0);5(5.0,6.0),7(5.8,8.0);5(5.0,6.0),7(5.8,7.3);5(5.0,6.0),6(5.0,7.0);5(4.5,5.0),5(4.0,5.3).The same thing in both states,there was no statistically difference in VAS at 2 h,4h and 48 h post-operation between group SSNB and group ISB(P>0.05).While group SSNB had lower VAS at 8 h,12 h and 24 h postoperatively compared with the group ISB(P<0.05).The dosage of flurbiprofen was 50(50.0,100.0)and 100(50.0,150.0)mg,respectively,with statistically significant differences(P<0.05).The utilization rate of pethidine in group SSNB was less than that in group ISB(P<0.05).The incidence of numbness of the affected limb in group SSNB was 0.00%(0/30)within 48 hours after the operation,and the numbness of the affected limb in group ISB was all numbness after the operation,and the numbness gradually disappeared within 48 hours.The incidence of nausea and vomiting within 48 hours after surgery was 6.67%(2/30)in group SSNB and 30.00%(9/30)in group ISB,with statistically significant differences(P<0.05).The analgesic satisfaction of SSNB group was higher than that of ISB group within 48 hours after surgery(P<0.05).Conclusion: Compared with conventional ultrasound-guided ISB,arthroscopy-guided SSNB has a better analgesic effect at the 8h,12 h and 24 h after arthroscopic supraspinatus and/or infraspinatus tendon repair,there was no obvious advantage after 2,4 and 48 h.The consumption of nonsteroidal anti-inflammatory drugs and opioid analgesics within 48 hours after surgery was less than ultrasound-guided ISB,with fewer side effects,which is conducive to early recovery and more acceptable to patients.