TABLE 3.
Outcomesa
| Study | Pain Outcome | Opioid Consumption Outcomes | Length of Stay Outcomes | Complications, No. of Patients/Total Patients Included | Other Outcomes |
|---|---|---|---|---|---|
| Aliste et al1 (2018) |
NRS Pain Scores
ISB group displayed significantly lower PACU pain scores at 30 min (difference of the medians, –4; 99% CI, –6 to –3). Although pain scores at 1, 2, and 3 h were lower in the ISB group, the upper bounds of the 99% CIs did not exceed the equivalence margin. |
Patients in the ISB group required less cumulative IV morphine at 24 h (difference of the means, –6.1; 95% CI, –10.5 to –1.6). | Not assessed. | ISB: hemidiaphragm paralysis, 18/20; Horner syndrome, 4/20; hoarseness, 2/20; paresthesia, 1/20. SSNB: paresthesia, 2/20. |
ISB resulted in a shorter mean (SD) performance time than the SSNB: 9.9 (4.6) vs 17.9 (10.1) min, respectively; P = .003. No difference in patient satisfaction at 24 h. |
| Auyong et al2 (2018) |
NRS Pain Scores
No difference in mean [SD] PACU pain scores at initial presentation (SSNB, 2.0 [3.0]; ISB, 2.0 [2.9]) or 1 h postoperatively (SSNB, 2.6 [2.7]; ISB, 2.1 [2.6]). |
Less intraoperative fentanyl with SSNB group (23 [30] μg) compared with ISB (36 [42] μg). Similar total PACU opioid consumption (SSNB, 52 [59] μg; ISB, 51 [85] μg). |
No significant difference between SSNB (98 [34] min) and ISB (102 [35] min). | ISB: subjective dyspnea, 4/61; Horner syndrome, 18/61; hoarseness, 14/61. SSNB: subjective dyspnea, 1/60; Horner syndrome, 5/60; hoarseness, 5/60. |
Satisfaction at 24-h assessment was at least 95% for each group, and there was no evidence of group differences. |
| Desroches et al6 (2016) |
VAS Pain Scores, Mean (SD)
Preoperative, 6.5 (2); postoperative, 2.4 (2.3) (P = .003). Mean 24-h postoperative pain: SSNB, 2.9 (2); ISB, 2.9 (2.1). One-way analysis of variance (changes in VAS according to sex, age, working status, preoperative VAS scores), P = .11, not significant. |
No significant difference in percentage of patients taking opium-like analgesics in the recovery room (P = .55), on postoperative day 1 (P = .67), or on postoperative day 2 (P = 1). | No difference in length of stay in recovery room because all patients were released 2 h after surgery. | No symptoms of neuropathy at 6 mo. 1 case of pneumothorax in control group (ISB). | No difference in cost between ISB and SSNB. Mean duration to perform SSNB was shorter (2 min vs 12 min for ISB), and SSNB did not require ultrasonography. |
| Dhir et al7 (2016) |
NRS Pain Scores
Higher scores for SSNB and ANB (5.45) in PACU compared with ISB (1.8) (P < .001). NRS scores were comparable at 6 h (4.0 vs 2.35, P = .064). Pain control was superior in the SSNB and ANB (3.92) group at 24 h compared with ISB (6.35) (P < .05). No difference in pain scores at 7-day follow-up (2.08 vs 2.76, P = .315). |
Significantly less opioid use intraoperatively and in PACU for interscalene block group. Unable to analyze opioid use post-discharge due to inconsistent data collection. | Not assessed. | Significant numbness and tingling in ISB group at 6 h (P < .001) and significantly less nausea and vomiting in SSNB and ANB group at 24 h (P = .028). However, no difference in nausea, vomiting, or numbness at 7 d. | Satisfaction was higher in ISB group at 6 h (P = .02), but there was no difference at later time periods. |
| Ikemoto et al21 (2010) |
VAS Pain Scores
No statistical difference across groups. At 0, 8, 16, and 24 h, mean (range) pain scores in the SSNB group were 5.8 (0-10), 5.5 (0-10), 5.8 (2-10), and 5.1 (2-8). ISB group, 6.2 (0-10), 5.6 (0-10), 4.5 (0-8), 3.8 (0-9). Control group, 6.0 (0-10), 5.4 (0-10), 4.6 (0-7), 4.3 (0-10). |
In SSNB, consumption was 3.1 ampoules of analgesics, 1.05 ampoules of anti-inflammatory agents, and 1.2 ampoules of opioids. In ISB group, 5.4 ampoules of analgesics, 2.7 ampoules of anti-inflammatory agents, and 0.8 ampoules of opioids. In control group, 4.2 ampoules of analgesics, 2.2 ampoules of anti-inflammatory agents, and 1 ampoule of morphine. |
Not assessed. | Not reported. | None. |
| Jeske et al23 (2011) |
VAS Pain Scores
VAS both with rest and activity was significantly lower in SSNB group (rest, 0.4; activity, 0.6) compared with both placebo (rest, 2.4; activity, 3.9) and subacromial infiltration (rest, 3.1; activity, 4.9) at 6 h after surgery (P < .001). |
Not assessed. | Not assessed. | No complications (neurovascular, infectious, or traumatic) observed. | Patient-reported satisfaction was significantly higher at 2 d (P < .001) and 14 d (P < .005) for SSNB group compared with placebo and subacromial infiltration groups. No differences in satisfaction after 6 wk. |
| Kumara et al27 (2016) |
VAS Pain Scores
ISB group had significantly lower VAS pain scores at 30 min, 1 h, and 2 h postoperatively (2.03, 1.67, 1.93) than SSNB group (4.1, 3.27, 2.53) (P = .001, .001, .002). |
Not assessed because only diclofenac was used in postoperative analgesia. | Not assessed. | Not assessed. | None. |
| Lee et al30 (2015) |
VAS Pain Scores
VAS scores at 1, 3, 6, 12, 18, and 24 h did not differ significantly between SSNB group (6.9, 4.9, 3.9, 3.3, 2.9, 2.4) and placebo group (6.9, 5.2, 4.2, 3.6, 3.0, 2.5). |
Number of boluses and total amount of fentanyl were significantly less in treatment group (P < .05). | No significant difference in length of stay (P > .05). | Incidence of nausea and vomiting was not significantly different between groups (P > .05). | None. |
| Neuts et al36 (2018) |
NRS Pain Scores
During the first 4 h after surgery, the difference in mean NRS at rest between SSNB and ISB was higher than 2.0, thereby suggesting analgesic inferiority of SSNB. After 8 h, the difference became inconclusive. During the night and after 24 h, the intergroup difference was very small, and the confidence interval included 0, thus resulting in a conclusion of noninferiority. |
Piritramide consumption was significantly higher in the SSNB group in the PACU (P = .004), from discharge to the ward until 4 h after surgery (P < .001), and from 4 to 8 h after surgery (P = .017). No difference from 8 to 24 h after surgery (P > 0.300). Mean total IV piritramide used during first 24 h after surgery was slightly higher with ISB compared with SSNB, 17.77 (14.62) mg vs 13.85 (12.50) mg, (P = .1889). |
Not assessed. | In the PACU, 14 patients (28%) in the ISB group experienced dyspnea vs 4 patients (8.3%) in the SSNB group. | Quality of sleep on the first postoperative night was similar in the ISB and SSNB groups (mean NRS, respectively, 4.62 and 4.71; P = .908). Overall patient satisfaction with pain therapy was also similar in the ISB and SSNB groups (mean NRS, respectively, 8.68 and 8.28; P = .131). |
| Ovesen et al37 (2014) |
VAS Pain Scores, Mean [SD]
Significantly lower scores in ISB compared with SSNB in PACU (0.09 [0.43] vs 0.096 [1.73], P = .037) and at 4 h (0.68 [1.25] vs 1.70 [1.66], P = .036) postoperatively. No difference between ISB (3.09 [2.49]) and SSNB (3.21 [2.51]) at 24 h. No significant difference between SSNB and control at 0, 4, and 24 h (0.96 [1.73], 1.70 [1.66], 3.21 [2.51] vs 1.30 [2.2], 1.5 [1.35], 2.45 [2.33]). |
No significant difference in total morphine (mg per 24 h) consumption between SSNB (3.65 [7.71]) and ISB (2.0 [4.7]) or control (5.67 [10.46]). | Not assessed. | SSNB: Nausea/vomiting, 1/23; “dead arm,” 1/23; local tenderness, 3/23. ISB: Nausea/vomiting, 1/22; “dead arm,” 5/22; local tenderness, 4/22. |
None. |
| Park et al38 (2016) |
VAS Pain Score, Mean
VAS scores in the group with PCA, SSNB, and ANB (6.4, 4.1) and the group with PCA and SSNB (7.2, 5.1) were significantly lower than the group with only PCA (7.9, 6.2) (P < .01) at 1 and 6 h postoperatively. The group with PCA, SSNB, and ANB (5.6, 4.0) had significantly lower VAS scores than the group with PCA and SSNB (6.6, 4.9) at 12 and 36 h (P < .01). |
Not assessed. | Not assessed. | Groups with nerve blocks had no neurological complications. | None. |
| Pitombo et al40 (2013) | No pain scores were measured. Mean duration of analgesia was significantly higher in the axillary and suprascapular nerve block group (P < .05). |
Rescue morphine consumption was significantly higher in the suprascapular and axillary nerve block group in the PACU (P < .05), but not at later times postblock. | Not assessed. | No complications like pneumothorax, accidental epidural analgesia injection, or adverse effects were observed. No statistically significant difference in rates of nausea and vomiting (P = .961). |
Discomfort with motor paralysis 24 h postblock was significantly lower in the axillary and suprascapular block group (P < .05). Significantly less motor block in the suprascapular and axillary nerve block group compared with ISB (P < .05). |
| Singelyn et al47 (2004) |
VAS Pain Scores, Mean
SSNB group had lower VAS scores during rest at 4 h and 24 h postoperatively (1.9, 1.1) compared with intra-articular injection (4.0, 3.0) (P < .001). VAS scores during movement were significantly lower (3.5) than intra-articular injection (6.1) at 24 h postoperatively (P < .001). ISB group showed significantly lower VAS scores (1.3, 1.3) during movement in PACU and 4 h postoperatively than SSNB (5.4, 3.5) (P < .01). |
Morphine use was significantly lower in the ISB group compared with SSB, intra-articular injection, and control groups (P < .01). | Not assessed. | Side effects included sedation, local tenderness, and nausea/vomiting. Incidence of nausea/vomiting was significantly lower in the ISB group than in the control group (P < .05). | Patient satisfaction at 24 h was significantly higher in the ISB group (P < .01). |
| Wiegel et al49 (2017) |
NRS Pain Scores
SSNB group pain scores were noninferior to ISB group (P < .0001). Number of patients reporting significant pain (NRS >3) was not significantly different between ISB (25%) and SSNB (30%) groups (P = .37). |
Piritramide use in PACU did not differ significantly between ISB and SSNB groups (P = .99). | Not assessed. | ISB group had significantly higher incidence of side effects, including hoarseness (P < .05), Horner syndrome (P < .001), and dyspnea (P < .05). | SSNB group reported significantly higher satisfaction (P < .001). SSNB group also demonstrated significantly higher grip strength 24 h after operation (P < .001). |
aANB, axillary nerve block; ISB, interscalene block; IV, intravenous; NRS, numerical rating scale; PACU, postanesthesia care unit; PCA, patient-controlled analgesia; SSNB, suprascapular nerve block; VAS, visual analog scale.