Supraclavicular regional anesthesia is a safer alternative in the immediate postoperative period after shoulder arthroscopy: A systematic review & meta-analysis.

Abstract

Interscalene nerve blocks (ISB) are commonly used for arthroscopic shoulder surgeries due to their efficacy but carry a risk of hemidiaphragmatic paralysis (HDP). Supraclavicular nerve blocks (SCB) have been proposed as an alternative, offering similar analgesic benefits with potentially lower respiratory complication rates. The purpose of this systematic review and meta-analysis was to compare ISB and SCB respiratory outcomes following arthroscopic shoulder surgery. A systematic review was conducted per PRISMA guidelines, with articles from Medline, Embase, and the Cochrane Library. Five double-blinded randomized controlled trials, comprising 420 patients, met the inclusion criteria. Primary outcomes included rates of HDP, diaphragmatic excursion, pulmonary function tests, and additional postoperative complications such as Horner's syndrome, dyspnea, and nausea. Statistical analyses were performed to evaluate differences between ISB and SCB groups. ISB was associated with a significant reduction in postoperative forced expiratory volume in one second (FEV1) compared to SCB in both the post-anesthesia care unit (PACU) (P = 0.04) and on postoperative day one (P = 0.002). While complete and partial HDP rates were numerically higher in the ISB group, the differences were not statistically significant. No significant differences were found between ISB and SCB in diaphragmatic excursion, Horner's syndrome, dyspnea, or postoperative nausea and vomiting. SCB may serve as a viable alternative to ISB as it offers comparable pain control and better preserves postoperative respiratory function. Given the significant reduction in FEV1 demonstrated by ISB, the SCB may be a better option for patients, particularly those with comorbidities and increased respiratory demand.