Effect Of Ultrasound-guided Supracapsular Nerve Combined With Axillary Nerve Block On Stress Response Of Shoulder Arthroscopic Surgery

Objective To investigate the effect of suprascapular nerve block combined with axillary nerve block on stress response of patients undergoing arthroscopic shoulder surgery.Methods sixty patients who underwent arthroscopic rotator cuff repair in our hospital from December 2020 to February 2022 were selected.Sixty patients were randomly divided into two groups（n=30）:general anesthesia combined with intermuscular sulcus brachial plexus block group（group A）and general anesthesia combined with suprascapular nerve combined with axillary nerve block group（group B）.After admission to the operating room,lower limb vein access was opened in both groups,radial artery puncture was performed on the upper limb of the healthy side,and invasive arterial pressure（IBP）,heart rate（HR）,electrocardiogram（ECG）and blood oxygen saturation（Sp O₂）were monitored.15min before induction of anesthesia,group A underwent ultrasound-guided intermuscular sulcus brachial plexus block and was given 0.5%ropivacaine 20ml.Group B received ultrasound-guided supracapsular nerve block and axillary nerve block,and each group was given 0.5%ropivacaine10ml.Fifteen minutes later,the effect of nerve block was evaluated satisfactorily,and general anesthesia was performed.Venous blood samples were collected at entry（T₀）,skin incision（T₁）,30min at the beginning of surgery（T₂）,60min at the beginning of surgery（T₃）,10min after extubation（T₄）,1h after surgery（T₅）,6h after surgery（T₆）,and 24h after surgery（T₇）,respectively.Serum levels of Cor,TNF-α,IL-10,β-EP and ST were determined by ELISA.Mean arterial pressure（MAP）and HR at T₀～T₄time points were recorded.Operation duration（min）,extubation duration（min）,fluid intake（ml）and intraoperative remifentanil dosage（mg）were recorded.The static VAS score at T₄～T₇time point was recorded.The motor function of forearm was evaluated by modified Bromage.Postoperative nausea and vomiting were recorded from T₅to T₇.Results（1）There were no significant differences in general information,intraoperative fluid intake,operation duration,extubation duration and remifentanil dosage between the two groups（P>0.05）;（2）Compared with T₀,MAP and HR at T₁to T₃were decreased（P<0.05）,and there were no significant differences in MAP and HR at T₀to T₃compared with group A（P>0.05）;（3）Compared with T₀time point,Cor,TNF-α,IL-10,β-EP and ST were all decreased in both groups from T₁to T₄（P<0.05）;Compared with group A,there was no significant difference between the two groups at T₀to T₄（P>0.05）,the above indexes were increased at T₅in group B（P<0.05）,and decreased at T₄and T₇in group B（P<0.05）;（4）Compared with T0 time point,the static VAS at T₄to T₇time point in both groups increased（P<0.05）;Compared with group A,the static VAS score at T₄,T₆and T₇was not statistically significant（P>0.05）,but increased at T₅in group B（P<0.05）;（5）In group A,there were 30 patients with grade 5 forearm muscle strength at time point T5,accounting for 100%;At T₆time point,there were 1₆patients with grade 3 forearm muscle strength,accounting for 53%,and 14 patients with grade 2 forearm muscle strength,accounting for 47%.At T₇time point,3 patients had grade 1 forearm muscle strength,accounting for 10%,and the remaining 27 patients had grade 0 forearm muscle strength,accounting for 90%.In group B,the forearm muscle strength of 30patients at T₅～T₇time point was grade 0,accounting for 100%.Compared with group A,group B had better forearm motor function from T₅to T₇（P<0.05）;（6）In group A,there were 9（30%）patients with vomiting at TIME point T₅,11（37%）patients at time point T₆,and 0 patients at time point T₇;There were 0 cases of nausea and vomiting in group B from T₅to T₇.Compared with group A,the incidence of nausea and vomiting in group B was lower（p<0.05）.Conclusion 1.Ultrasound-guided supracapsular nerve block combined with axillary nerve block is safe and feasible for shoulder arthroscopic surgery,which can reduce intraoperative stress response and maintain intraoperative hemodynamic stability.2.Suprascapular nerve combined with axillary nerve block can provide satisfactory postoperative analgesia,and does not affect postoperative activities at all,which is conducive to early postoperative rehabilitation and exercise;3.The incidence of vomiting after suprascapular nerve block combined with axillary nerve block was lower than that after intermuscular sulcus brachial plexus block.