Pain-relief Alternatives for Shoulder Surgery (PASS trial): The novel combination of suprascapular and axillary nerve blocks versus conventional interscalene brachial plexus block for pain relief following shoulder surgery. A two-centred randomized, patient and assessor blinded, non-inferiority trial.

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Project Title

Pain-relief Alternatives for Shoulder Surgery (PASS trial): The novel combination of suprascapular and axillary nerve blocks versus conventional interscalene brachial plexus block for pain relief following shoulder surgery. A two-centred randomized, patient and assessor blinded, non-inferiority trial.

Proposal Abstract

Shoulder surgery causes moderate-to-severe pain in 70% of patients. The interscalene block (ISB) is a technique where we inject local anesthetics in the neck before surgery to freeze the nerves that conduct shoulder pain. The ISB reduces surgical pain, decreases narcotic pain medication usage, and lowers the risk of nausea and vomiting after shoulder surgery. As such, the ISB is the standard of practice in most hospitals. However, the neck where the ISB is done is packed with nerves and blood vessels. Compared to other blocks, the ISB is more invasive and carries a higher risk of injury to nerves and blood vessels, as well as breathing and blood pressure complications. Though it’s an opportune time for ISB alternatives, the proposed substitutes have not been as effective. However, a newly described suprascapular-axillary block combination (SAB) where freezing is injected around the shoulder, not the neck, may be promising. As we have little data of how the SAB compares to ISB, we propose to compare these blocks in shoulder surgery. We will give patients either SAB or ISB and study their pain relief. We think that the SAB will be as good as ISB for pain relief, but will improve safety and reduce complications.

Reporting Abstract

This randomized controlled study evaluated the use of suprascapular-axillary block (SAB) combination as an alternative technique to interscalene block (ISB) in 136 patients for pain relief after arthroscopic shoulder surgery. We hypothesized that SAB offered non-inferior pain relief but a lower risk of respiratory, neurologic and vascular complications than ISB. Our primary outcome measure was postoperative pain relief at 6 hours after surgery and secondary outcome measures were postoperative rest pain at other time points and postoperative quality of recovery (QoR). Our results show that patients had similar demographic and surgical profile except they were older in the SAB group (45.9 yo vs. 39.8 yo). Pain score (numeric rating scale, NRS) at 6 h was similarly low in both groups (1.75 vs. 1.35). Also, the 2 groups had similar area under the curve for postoperative NRS pain scores and QoR-15 score in the first 24 hours, PACU complications, neurologic complications and patient satisfaction. Opioid consumption (IV morphine equivalent) was slightly higher with SAB (5.65 mg vs. 3.19 mg) in the PACU but not different in 24 h.

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MSU - Mount Sinai Hospital - University Health Network Academic Medical Organization

Project Summary

MSU - Mount Sinai Hospital - University Health Network Academic Medical Organization

Project Summary

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