TABLE 2.
Details of the Nerve Blocks and Anesthesia Useda
| Study | Anesthesia | Treatment Technique | Control Technique | Analgesia Used |
|---|---|---|---|---|
| Aliste et al1 (2018) | GA | 10 mL of 1% lidocaine. Lateral decubitus position. The US transducer was applied cephalad and parallel to the scapular spine to obtain a view of the suprascapular fossa. With an in-plane technique and a lateral-to-medial direction, the block needle was advanced until its tip was located in the floor of the suprascapular fossa, ventral to the fascia of the supraspinatus muscle. | 20 mL of 1% lidocaine. The US transducer was applied on the lateral side of the neck at the level of the cricoid cartilage to obtain a view of the brachial plexus. The block needle was advanced until its tip was positioned under the prevertebral fascia between the 2 most superficial hypoechoic structures. | In the PACU, all patients received acetaminophen 1 g IV, ketoprofen 100 mg IV, and patient-controlled analgesia (1-mg bolus doses of morphine with a lockout interval of 8 min). Afterward, all patients continued to receive acetaminophen 1 g by mouth every 8 h and ketoprofen 100 mg by mouth every 12 h as well as patient-controlled morphine. |
| Auyong et al2 (2018) | GA | 15 mL of 0.5% ropivacaine. The suprascapular nerve was traced laterally as it branched away from the superior trunk or C5 nerve root in the supraclavicular fossa on the anterior lateral portion of the neck. The injection endpoint was immediately beneath the suprascapular nerve. | 15 mL of 0.5% ropivacaine. ISB: US probe was used. The needle was inserted with in-plane technique into the interscalene grove. The injection endpoint was posterior to the brachial plexus at this level. Supraclavicular block: US probe was used. An in-plane technique was used to reach the endpoint at the superior portion of the brachial plexus that corresponds to the superior and middle trunks. |
In the PACU, the opioid algorithm was as follows immediately following surgery: (1) for NRS pain score of 4-6, the patient received 25 μg of fentanyl IV; (2) for NRS score 7-10, the patient received 50 μg of fentanyl IV. Oral oxycodone, if necessary, was dosed using the following criteria: (1) for NRS score 4-6, the patient received 5 mg; (2) for NRS score 7-10, the patient received 10 mg. |
| Desroches et al6 (2016) | GA | 10 mL of 0.75% ropivacaine. The needle was inserted at the midpoint of the line connecting the anterolateral edge of the acromion and the superomedial angle of the scapula. The needle was advanced at an angle of 30° to contact the base of the coracoid process, and the anesthetic was injected slowly. | Both neurostimulation at 0.8 mA and US guidance were used. Posterior and anterior diffusions were checked during the injection. If diffusion was insufficient, the needle was moved for correct diffusion. 20-mL bolus of 0.75% of ropivacaine. |
In the recovery room: 1 g of acetaminophen, 100 mg of ketoprofen, 100 mg of tramadol IV were given. If VAS >3, the patient received 3 mg of morphine IV; 5 min later, if VAS >3, the patient received another 3 mg of morphine IV. |
| Dhir et al7 (2016) | GA | The needle was inserted with dual guidance along the long axis. 15 mL of 0.5% ropivacaine was injected in the supraspinatus fossa after stimulation of supraspinatus and/or infraspinatus was observed. | US guidance with nerve stimulation assistance was used for lateral-to-medial in-plane ISB block with 20 mL of 0.5% ropivacaine. Target was C6 in interscalene groove, which was confirmed with deltoid motor response. | In the PACU, all patients received ketorolac and acetaminophen, plus opioids as needed. Patients were prescribed oral opioids and instructed to take them every 4-6 h as needed when discharged. |
| Ikemoto et al21 (2010) | GA | Two-thirds of 2 mg/kg of 0.5% ropivacaine was used; the remaining third was applied in the subacromial space. | 2 mg/kg of 0.5% ropivacaine. | After the procedure, simple analgesics, opioid analgesics, and anti-inflammatory agents were administered as requested by the patient. |
| Jeske et al23 (2011) | GA | 10 mL of 0.1% ropivacaine. The scapular spine and acromion were palpated, and the total length between them was divided into 2 equal halves. The needle was placed 2 cm proximal and medial to this point and positioned laterally and caudally. Stimulation current was used to confirm motor response of the infraspinatus and supraspinatus. | See technique for treatment group; the placebo group received 10 mL of 0.9% saline and the subacromial infiltration group received 20 mL of 1% ropivacaine. | Postoperative analgesia consisted of 75 mg of diclofenac 4 h postoperatively for at least 48 h, in combination with 40 mg of pantoprazole. If VAS >3, patients received subcutaneous or oral morphine. If patients were pain free, then nonsteroidal anti-inflammatory agents were discontinued. |
| Kumara et al27 (2016) | GA | The scapula was divided into 4 quadrants created by the spine of the scapula and a vertical line parallel to the spine. The upper outer quadrant was then bisected, and 2 mL of 1% lignocaine was injected 2.5 cm along the plane of bisection. After location was confirmed with electrophysiological stimulation and negative aspiration, a 22-gauge needle was used to inject 15 mL of 0.5% bupivacaine with 75 μg of clonidine. An additional 5 mL of 0.5% bupivacaine was infiltrated subcutaneously over the shoulder to block cutaneous sensory branches of C3 and C4 spinal nerves. |
The brachial plexus was approached at the level of C6, with the needle angled at 60° from the sagittal plane. The needle was introduced with an electrophysiological probe. After confirmation of location with electrical stimulation and negative aspiration, 20 mL of 0.5% bupivacaine and 75 μg of clonidine were injected. |
VAS was administered immediately upon admission to the PACU and then at 30 min, 1 h, 2 h, 4 h, 6 h, and 8 h. If VAS ≥4, then 75 mg of diclofenac was given via the intramuscular route. |
| Lee et al30 (2015) | GA | The suprascapular ligament and nerve were exposed via electrocautery through the anterior portal. An 18-gauge needle was inserted perpendicularly, 7 cm medial to the lateral margin of the acromion and above the previously located transverse suprascapular ligament. 10 mL of 0.5% ropivacaine was then injected, | Same as the treatment protocol but with 10 mL of saline. | Patient-controlled analgesia was provided, consisting of 1 μg/kg of fentanyl with a lockout time of 1 h and a maximum dose of 700 μg. |
| Neuts et al36 (2018) | GA | 10 mL 0.75 ropivacaine. Lateral decubitus position. A US-guided, in-plane, medial to lateral approach was used. The needle was positioned in the concave depression under the supraspinatus fascia. | 20 mL of 0.75% ropivacaine. US guided, in-plane technique through the middle scalene muscle was used. The tip of the needle was placed anterosuperior to the C6 root without making contact with neural structures. | Postoperative pain management included IV paracetamol (15 mg/kg 4 times a day), ketorolac (0.5 mg/kg 3 times a day), and patient-controlled intravenous analgesia with piritramide (bolus dose = 2 mg and lockout interval = 12 min). |
| Ovesen et al37 (2014) | GA | 20 mL of bupivacaine. The needle was introduced 1 cm cephalad to the middle of the spine of the scapulae and advanced parallel to the blade until the bony floor of the fossa supraspinatus reached. | ISB: 30 mL of ropivacaine. The block was performed by use of Winnie landmarks (palpating the interscalene groove at the level of the cricoid cartilage (C6 vertebra). A Stimuplex needle was connected to a peripheral nerve-stimulator introduced into the plexus sheath. Bursal block: 10 mL bupivacaine and 5 mL morphine were injected into subacromial space. |
All patients had 1 g of paracetamol 4 times a day and 600 mg of ibuprofen 3 times a day. If VAS >3, patients received 3-5 mg nicomorphine hydrochloride IV followed by 5 mg ketobemidone. |
| Park et al38 (2016) | GA | A line was drawn connecting the medial area of the acromion to the medial end of the spine of the scapula. The needle was inserted parallel to the vertebral column 2 cm medial and 2 cm cephalad to the midpoint of the previous line. 10 mL of 0.75% ropivacaine was injected with repeated withdrawal. | Same as treatment group. | All patients were administered pregabalin 75 mg, aceclofenac 100 mg, tramadol 37.5 mg, and acetaminophen 325 mg the night before the procedure. The patient-controlled analgesia consisted of 80 mL of saline with fentanyl 0.5 mg, ketorolac 180 mg, and ondansetron 12 mg in a time-release injection for 48 h. |
| Pitombo et al40 (2013) | GA | The puncture location was 2 cm medial to the posterior edge of the acromion and 2 cm cranial to the upper border of the scapular spine. After muscle response was confirmed via a neurostimulator, 15 mL of 0.33% levobupivacaine with 1:200,000 epinephrine was injected. |
The nerve block protocol was not detailed. After observation of motor response to neurostimulator, 30 mL of 0.33% levobupivacaine with 1:200,000 epinephrine was injected. |
Postoperative analgesia consisted of 2 g of dipyrone IV every 6 h. Pain was assessed by use of the VAS immediately in the PACU and 6 h, 12 h, and 24 h after nerve blockade. If VAS scores were ≥3, then a single dose of IV morphine at 0.04 mg/kg was used as rescue analgesia. |
| Singelyn et al47 (2004) | GA | A 5-cm, 21-gauge intramuscular needle was introduced 1 cm cephalad to the midpoint of the scapular spine and advanced. 10 mL of 0.25% bupivacaine with 1:200,000 epinephrine was injected. | Intra-articular anesthetic: 20 mL of 0.25% bupivacaine with 1:200,000 epinephrine was administered after skin closure at the end of the procedure. ISB: The needle was introduced into the plexus sheath with a peripheral stimulator. 20 mL of 0.25% bupivacaine with 1:200,000 epinephrine was injected. |
If VAS was >30, the patient received 2 g of IV propacetamol followed by 5 mg (if <60 kg body weight) or 10 mg (if >60 kg body weight) of subcutaneous morphine if VAS remained unchanged after 30 min. |
| Wiegel et al49 (2017) | GA | The needle was advanced through the inferior belly of the omohyoid and superficial to the prevertebral fascia and then visualized with US. 10 mL of 1% ropivacaine was injected. | US was used to identify the superior trunk of the brachial plexus. 20 mL of 0.75% ropivacaine was injected between the lateral aspect of the brachial plexus and middle scalene. | If the postoperative pain NRS score was >3, then 3 mg of IV piritramide was administered. |
aGA, general anesthesia; ISB, interscalene block; IV, intravenous; NRS, numerical rating scale; PACU, postanesthesia care unit; US, ultrasound; VAS, visual analog scale.