• David Petroff, Martin Wiegel, Virginia Pech, Peter Salz, Julia Mrongowius, and Andreas W Reske.
• From the Clinical Trial Centre, University of Leipzig (DP), ACQUA Clinic, Department of Anaesthesiology (MW, VP), Innovation Center Computer Assisted Surgery, University of Leipzig, Leipzig (PS, JM) and Department of Anaesthesiology and Intensive Care and Pain Medicine, Heinrich Braun Hospital Zwickau, Zwickau, Germany (AWR).
• Eur J Anaesthesiol. 2020 Dec 1; 37 (12): 1105-1114.

BackgroundUltrasound-guided interscalene brachial plexus block (ISB) is used to control pain after shoulder surgery. Though effective, drawbacks include phrenic nerve block and motor block of the hand. The ultrasound-guided anterior approach to perform suprascapular nerve block (SSNB) may provide a good alternative.ObjectiveTo compare lung ventilation and diaphragmatic activity on the operated side in ISB and SSNB.DesignRandomised, controlled patient-blinded and assessor-blinded trial.SettingOutpatient surgical clinic with recruitment from June 2017 to January 2018.PatientsFifty-five outpatients scheduled for arthroscopic shoulder surgery were allocated randomly to receive SSNB or ISB. Technical problems with monitoring devices unrelated to the intervention led to exclusion of seven patients. The remaining 48 (n=24 in each group) were followed up for 24 h without drop-outs.InterventionsPatients received 10 ml of ropivacaine 1.0% wt/vol for both procedures.Outcome MeasuresPercentage lung ventilation on the operated side was the primary endpoint as assessed with electrical impedance tomography (EIT). Secondary endpoints were hemidiaphragmatic motion on the operated side, pain, opioid use, hand strength and numbness, and patient satisfaction.ResultsBefore regional anaesthesia, the lung on the operated side contributed a median [IQR] of 50 [42 to 56]% of the total lung ventilation. Postoperatively, it was 40 [3 to 50]% (SSNB) vs. 3 [1 to 13]% (ISB) for an adjusted difference of 23 (95% CI, 13 to 34)%, (P < 0.001). Hemidiaphragmatic motion was 1.90 (95% CI, 1.37 to 2.44 cm), (P < 0.001) lower in the ISB group compared with the SSNB group. Hand strength was 11.2 (95% CI 3.6 to 18.9), (P = 0.0024) kg greater for SSNB and numbness was observed in 0% (SSNB) vs. 46% (ISB) of patients, P < 0.001. Pain was low in the first 6 h after surgery in both groups with slightly, but not significantly, lower values for ISB. No meaningful or significant differences were found for opioid use or patient satisfaction.ConclusionAn ultrasound-guided anterior approach to SSNB preserves ipsilateral lung ventilation and phrenic function better than a standard ISB.Trial Registrationdrks.de identifier: DRKS00011787.

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