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Introduction <p>Shoulder arthroscopy is associated with significant postoperative pain. Interscalene brachial plexus block (ISBPB) provides excellent analgesia but frequently causes hemidiaphragmatic paralysis (HDP) and respiratory impairment. Cervical erector spinae plane block (ESPB) has been proposed as a possible alternative approach, but its comparative efficacy, safety, and anatomical spread remain uncertain.</p> Methods <p>In this randomized non-inferiority trial, 70 patients undergoing arthroscopic shoulder surgery received cervical ESPB or ISBPB with 20&#xa0;ml 0.375% ropivacaine. The primary endpoint was resting visual analog scale (VAS) pain at 6&#xa0;h. Secondary outcomes included static and dynamic VAS, diaphragm ultrasound, respiratory function, handgrip strength, opioid use, adverse events, and satisfaction.</p> Results <p>The median between-group difference in resting VAS at 6&#xa0;h was 0 (range 0–1), meeting the non-inferiority margin. VAS pain scores were lower with ISBPB at 1 and 3&#xa0;h at rest (<i>p</i> = 0.008 and <i>p</i> = 0.003) and at 3 and 6&#xa0;h during movement (<i>p</i> &lt; 0.001 and <i>p</i> = 0.007); however, all 95% confidence intervals for median differences were &lt; 1, confirming non-inferiority of ESPB. Cumulative sufentanil use and rescue analgesia were similar. ESPB was associated with greater diaphragmatic excursion and thickening fraction and a lower HDP incidence (RR 0.2 post-block; 0.4 in the PACU; both <i>p</i> &lt; 0.001). Respiratory declines were smaller with ESPB for FVC (5.8% vs. 14.8%; <i>p</i> &lt; 0.001), FEV₁ (4.9% vs. 18.8%; <i>p</i> &lt; 0.001), MIP and MEP (both <i>p</i> &lt; 0.001). Handgrip strength was better maintained and Horner syndrome was less frequent (8.6% vs. 34.3%; <i>p</i> = 0.018). Other adverse events and patient satisfaction were similar between groups.</p> Conclusions <p>In this low-risk study population, cervical ESPB met the predefined non-inferiority criterion for postoperative analgesia compared with ISBPB and was associated with less diaphragmatic and respiratory impairment. However, cervical ESPB should not be considered risk-free, and further anatomical, dose-finding, and clinical studies are needed before any broader clinical role can be defined.</p> Trial Registration <p>ClinicalTrials.gov identifier no. ChiCTR2200060019.</p>

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Cervical Erector Spinae Plane Block for Shoulder Arthroscopy: A Favorable Alternative to Interscalene Brachial Plexus Block? A Randomized Non-Inferiority Trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月13日

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  • Tie-shuai Liu,
  • Jun Zhang,
  • Yong-he Hu,
  • Qian Hu,
  • Qi-hong Shen,
  • Zi-ming Zhang,
  • Gang Chen

摘要

Introduction

Shoulder arthroscopy is associated with significant postoperative pain. Interscalene brachial plexus block (ISBPB) provides excellent analgesia but frequently causes hemidiaphragmatic paralysis (HDP) and respiratory impairment. Cervical erector spinae plane block (ESPB) has been proposed as a possible alternative approach, but its comparative efficacy, safety, and anatomical spread remain uncertain.

Methods

In this randomized non-inferiority trial, 70 patients undergoing arthroscopic shoulder surgery received cervical ESPB or ISBPB with 20 ml 0.375% ropivacaine. The primary endpoint was resting visual analog scale (VAS) pain at 6 h. Secondary outcomes included static and dynamic VAS, diaphragm ultrasound, respiratory function, handgrip strength, opioid use, adverse events, and satisfaction.

Results

The median between-group difference in resting VAS at 6 h was 0 (range 0–1), meeting the non-inferiority margin. VAS pain scores were lower with ISBPB at 1 and 3 h at rest (p = 0.008 and p = 0.003) and at 3 and 6 h during movement (p < 0.001 and p = 0.007); however, all 95% confidence intervals for median differences were < 1, confirming non-inferiority of ESPB. Cumulative sufentanil use and rescue analgesia were similar. ESPB was associated with greater diaphragmatic excursion and thickening fraction and a lower HDP incidence (RR 0.2 post-block; 0.4 in the PACU; both p < 0.001). Respiratory declines were smaller with ESPB for FVC (5.8% vs. 14.8%; p < 0.001), FEV₁ (4.9% vs. 18.8%; p < 0.001), MIP and MEP (both p < 0.001). Handgrip strength was better maintained and Horner syndrome was less frequent (8.6% vs. 34.3%; p = 0.018). Other adverse events and patient satisfaction were similar between groups.

Conclusions

In this low-risk study population, cervical ESPB met the predefined non-inferiority criterion for postoperative analgesia compared with ISBPB and was associated with less diaphragmatic and respiratory impairment. However, cervical ESPB should not be considered risk-free, and further anatomical, dose-finding, and clinical studies are needed before any broader clinical role can be defined.

Trial Registration

ClinicalTrials.gov identifier no. ChiCTR2200060019.