Purpose Interscalene (ISC) block is the gold standard for regional anesthesia in shoulder surgery but can cause phrenic nerve involvement and motor weakness. The shoulder anterior capsule (SHAC) block has emerged as a potential alternative with motor-sparing benefits. This study compared their analgesic efficacy and motor preservation in arthroscopic rotator cuff repair. Methods In a single-center, single-blinded, randomized controlled trial, 46 adult patients (ASA I–III) who underwent arthroscopic rotator cuff repair were assigned to receive either an ultrasound-guided ISC block (n = 23) or SHAC block (n = 23), followed by general anesthesia. The primary outcome was the pain score at the 8th postoperative hour. The secondary outcomes included motor strength, opioid consumption, intraoperative fentanyl requirement, and satisfaction scores. Results 40 participants (ISC = 20, SHAC = 20) were included in the final analysis. The ISC group had significantly lower pain scores at 1, 2, 4, 8, 12, 16, and 24 h postoperatively (p < 0.05). Motor function was better preserved in the SHAC group during the first 4 h postoperatively, with median (25th − 75th percentile) elbow strength scores of 2.0 (1.25–2.75) at 1 h and 3.0 (<CitationRef CitationID="CR3">3</CitationRef>, <CitationRef CitationID="CR4">4</CitationRef>) at 4 h, compared with 0.0 (0–1) and 1.0 (0.25–2.75) in the ISC group, respectively (p < 0.01). However, no significant differences were observed beyond 8 h. Intraoperative fentanyl consumption was higher in the SHAC group (105 [100–150] mcg) than in the ISC group (50 [50–50] mcg), and 24-hour postoperative fentanyl use was also greater in the SHAC group (140 [82.5–170] mcg vs. 5 [0–27.5] mcg; both p < 0.001). Patient satisfaction at 24 h was lower in the SHAC group (4.0 [3.25–5.0]) compared with the ISC group (5.0 [5–5]; p = 0.001), whereas surgeon satisfaction was similar between the groups. Conclusion Although SHAC block preserves shoulder motor function, it provides less effective analgesia and requires more opioids, which is associated with lower patient satisfaction. Trial registration (ClinicalTrials.gov) Number: NCT06827912 Date when the study was first posted on ClinicalTrials.gov: 02/10/2025 Date of enrollment of the first research participant: 02/20/2025

Comparison of interscalene block versus shoulder anterior capsule block for postoperative pain management in rotator cuff surgery: a randomized controlled trial

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2025年9月29日

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Bülent Meriç Çam,
Ahmet Salih Tüzen,
Harun Tolga Duran,
Muhammet Aydın Akdoğan

摘要

Purpose

Interscalene (ISC) block is the gold standard for regional anesthesia in shoulder surgery but can cause phrenic nerve involvement and motor weakness. The shoulder anterior capsule (SHAC) block has emerged as a potential alternative with motor-sparing benefits. This study compared their analgesic efficacy and motor preservation in arthroscopic rotator cuff repair.

Methods

In a single-center, single-blinded, randomized controlled trial, 46 adult patients (ASA I–III) who underwent arthroscopic rotator cuff repair were assigned to receive either an ultrasound-guided ISC block (n = 23) or SHAC block (n = 23), followed by general anesthesia. The primary outcome was the pain score at the 8th postoperative hour. The secondary outcomes included motor strength, opioid consumption, intraoperative fentanyl requirement, and satisfaction scores.

Results

40 participants (ISC = 20, SHAC = 20) were included in the final analysis. The ISC group had significantly lower pain scores at 1, 2, 4, 8, 12, 16, and 24 h postoperatively (p < 0.05). Motor function was better preserved in the SHAC group during the first 4 h postoperatively, with median (25th − 75th percentile) elbow strength scores of 2.0 (1.25–2.75) at 1 h and 3.0 (3, 4) at 4 h, compared with 0.0 (0–1) and 1.0 (0.25–2.75) in the ISC group, respectively (p < 0.01). However, no significant differences were observed beyond 8 h. Intraoperative fentanyl consumption was higher in the SHAC group (105 [100–150] mcg) than in the ISC group (50 [50–50] mcg), and 24-hour postoperative fentanyl use was also greater in the SHAC group (140 [82.5–170] mcg vs. 5 [0–27.5] mcg; both p < 0.001). Patient satisfaction at 24 h was lower in the SHAC group (4.0 [3.25–5.0]) compared with the ISC group (5.0 [5–5]; p = 0.001), whereas surgeon satisfaction was similar between the groups.

Conclusion

Although SHAC block preserves shoulder motor function, it provides less effective analgesia and requires more opioids, which is associated with lower patient satisfaction.

Trial registration (ClinicalTrials.gov)

Number: NCT06827912

Date when the study was first posted on ClinicalTrials.gov: 02/10/2025

Date of enrollment of the first research participant: 02/20/2025