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ORIGINAL ARTICLE
Year : 2019  |  Volume : 17  |  Issue : 3  |  Page : 281-287

Interscalene versus combined supraclavicular with suprascapular ultrasound-guided nerve blocks in arthroscopic rotator cuff surgery with levobupivacaine


Department of Anesthesia, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Correspondence Address:
Ahmed G.S El Sawy
5240 Andrya Street, Mokattam, Cairo, 11571
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AZMJ.AZMJ_66_19

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Background In recent years, shoulder arthroscopy has been used as a diagnostic and therapeutic maneuver. With the introduction of ultrasound, peripheral nerve block has increasingly been performed by the anesthesiologist, because it increases the success rate of the block. Interscalene block is suitable for arthroscopic shoulder surgery, but many complication may affect the respiratory system. Ultrasound-guided supraclavicular with suprascapular nerve block may be a safe alternative for arthroscopic shoulder surgery. Levobupivacaine is a local anesthetic. It is the S enantiomer of bupivacaine with long duration of action, motor block, and onset time. Aims The primary outcome of the study is the quality of the block (sensory and motor), whereas the postoperative analgesia and patient satisfaction are the secondary outcomes in arthroscopic rotator cuff surgery. Settings and design This was a prospective randomized comparative clinical study. Patients and methods A total of 60 patients between 25 and 55 years were included in this study. The patients scheduled for elective arthroscopic rotator cuff surgery were randomized into two groups: group A patient received ultrasound-guided interscalene brachial plexus block with levobupivacaine, and group B patient received ultrasound-guided supraclavicular with suprascapular brachial plexus block with levobupivacaine. Results The mean age of all arthroscopy patients was 43.1±8.8 years, and most patients were males (60%), whereas 40% were females. On comparing the two groups, we found no statistically significant difference regarding basic preoperative, hemodynamic, and intraoperative data. Regarding the primary outcome, there was a significant increase in success rate (block quality) in group B (93.3%) compared with group A patients (70%) (P=0.02) and nonsignificant difference regarding sensory and motor block onset (P>0.05). Regarding secondary outcomes, there was a highly significant decrease in rescue analgesia in B group (average 1.9±0.7 ampoules) compared with group A patients (average 2.5±0.7 ampoules) (P=0.008), a significant decrease in complications rate in group B (0%) compared with group A patients (26.7%) (P=0.026), and a highly significant increase in patient satisfaction rate in group B (100%) compared with group A patients (70%) (P=0.004). Conclusions Suprascapular brachial plexus block can be performed as an alternative to interscalene brachial plexus block in patients undergoing arthroscopic shoulder surgery.


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