Ultrasound-guided interscalene plexus block versus combined ultrasound-guided suprascapular and axillary nerve blocks for proximal humerus fracture surgeries: A randomized controlled study.

Abstract

Background & objective: During the recent past, a renewed interest in regional nerve blocks for intra- as well as postoperative pain management has surged. Interscalene nerve block (ISB) represents an effective regional
approach for most of the shoulder surgeries. Nevertheless, it is associated with significant adverse effects. This study aimed to assess the efficacy and safety of the combined suprascapular and axillary nerve block (SSNB/ANB) in comparison to ISB in providing analgesia for surgeries in proximal humerus fractures.

Methods: This clinical trial enrolled 50 patients of both genders with American Society of Anesthesiologists class I-II status scheduled for shoulder surgery under general anesthesia. The patients were assigned to two groups of 25 individuals each. The SSNB/ANB group and the ISB group. The primary outcome was the postoperative visual analog scale (VAS). Secondary outcomes included the amount of analgesic consumption at various time points during the first 24 hours post-surgery, the time of rescue analgesia, and the incidence of adverse effects.

Results: Patients in the SSNB/ANB group exhibited significantly elevated VAS scores in the early postoperative period and comparable scores at 12 and 24 hours postoperatively (P = 0.312 and 0.115, respectively). Additionally, they required a greater quantity of pethidine at various postoperative time points and exhibited a shortened interval before the onset of the need for rescue analgesia when compared to the ISB group. Nevertheless, hemidiaphragmatic paralysis, hypoxia, and hoarseness of voice incidences were significantly higher in the ISB group.

Abbreviations: ANB: axillary nerve block, BMI: body mass index, ISB: Interscalene nerve block, SSNB:
suprascapular nerve block, VAS: visual analog scale

Keywords: Anesthesia; Axillary nerve block; General Anesthesia; Interscalene block; Nerve block; Suprascapular
nerve block; VAS

Conclusion: In proximal humeral fracture surgery, the combined SSNB/ANB provided analgesia comparable to thatof the ISB at 12 and 24 hours postoperatively, with minimal adverse effects.

Citation: Ehab AM, Nady RF, Azzam FMA. Ultrasound-guided interscalene plexus block versus combined
ultrasound-guided suprascapular and axillary nerve blocks for proximal humerus fracture surgeries: A randomized controlled study. Anaesth. pain intensive care 2025;29(8):998-1006.

DOI: 10.35975/apic.v29i8.3036