Application Of Ultrasound-guided Suprascapular Nerve Combined With Costoclavicular Brachial Plexus Block In Shoulder Arthroscopy

ObjectiveTo compare the application of ultrasound-guided posterior suprascapular nerve block combined with costoclavicular brachial plexus block and ultrasound-guided interscalene brachial plexus block in the operation of shoulder arthroscopy,the purpose of this study is to evaluate the incidence of hemidiaphragmatic paralysis and the analgesic effect.Methods1.From October 2019 to January 2020,50 patients with shoulder arthroscopy were selected.The age was 18-74 years old.ASA was classified as grade I-II.Using random number table method,the patients were randomly divided into two groups:suprascapular nerve block（SSB）combined with costoclavicular brachial plexus block（CCB）group（SC group）and interscalene brachial plexus block（ISB）group（I group）.25 cases in each group.2.The patients in the two groups were fasting for 8h and drinking for 4h before operation.After entering the anesthesia preparation room,check the patient’s information,routine monitoring of vital signs（Sp O₂,NIBP,ECG）,Open the peripheral vein of the healthy upper arm for rehydration.3.Midazolam 2mg was injected intravenously before nerve block in both groups,and 0.5%ropivacaine 3m L supraclavicular nerve（SCN）block was performed under the guidance of ultrasound in both groups.4.After SCN block,the SSB-CCB was guided by ultrasound in group SC,the ISB was guided by ultrasound in group I,and 0.5%ropivacaine 10m L was injected into each nerve block slowly.30 minutes later,the patients were sent to the operating room.5.General anesthesia was performed in both groups.During the operation,sufentanil was injected intravenously according to HR and NIBP.When HR and/or NIBP increased to more than 20%of the basic value,sufentanil 5-10μg was injected intravenously.6.The operation time of nerve block,the perfect time of sensory and motor block,the success rate of nerve block and the duration of analgesia were recorded.The diaphragmatic mobility and function were recorded before nerve block（T0）,30 min after nerve block（T1）,30 min after extubation（T2）,8 h after nerve block（T3）by VS test.The VAS was recorded at 0.5,2,4,8,12 and 24 hours after operation.The amount of sufentanil used during the operation and the amount of tramadol used to relieve pain after the operation were recorded.Complications were recorded:sinus bradycardia（intravenous injection of0.5mg atropine when HR<50bpm）,dyspnea,Horner’s syndrome,hoarseness,PONV;satisfaction of patients was recorded.Results1.General data:there was no significant difference in gender,age,BMI,ASA grade,operation time,sufentanil dosage and extubation time between the two groups（P>0.05）.2.Compared with group I,the operation time of nerve block in group SC was significantly increased,the duration of analgesia was significantly prolonged,and the dosage of tramadol was significantly reduced,the difference was statistically significant（P<0.05）.There was no difference in the perfect time of sensory and motor block and the success rate of nerve block between the two groups（P>0.05）.3.Measurement of diaphragmatic mobility by VS test and the VAS scores of each time point in two groups were analyzed by ANOVA of repeated measurement design.Results:Compared with group I,the degree of diaphragmatic displacement of SC group was better at T1,and the analgesic effect of SC group was better at 8h after operation,the difference was statistically significant（P<0.05）.4.Compared with group I,the incidence of HDP in SC group decreased significantly 30 minutes after nerve block and 30 minutes after extubation,the incidence of sinus bradycardia and PONV decreased significantly,the difference was statistically significant（P<0.05）.No difference in patient satisfaction（P>0.05）.5.In addition,there were 1 case of dyspnea,1 case of Horner’s syndrome and 3 cases of hoarseness in group I.No complications of this kind of nerve block were found in SC group.ConclusionCompared with ISB,SSB-CCB can cause less phrenic nerve block,so as to avoid HDP and preserve the function of diaphragm better.At the same time,the postoperative analgesia time of combined nerve block is significantly longer,the postoperative analgesia effect is better,the patients’satisfaction is high,and the adverse reactions are less,which can provide another alternative way of postoperative analgesia for shoulder arthroscopic surgery.