Surgery · 3 h ago
Shoulder field anesthesia noninferior to interscalene block in 80-patient trial
In a randomized trial of 80 patients undergoing arthroscopic shoulder surgery, surgeon-performed shoulder field anesthesia (SFA) was noninferior to interscalene block (ISB) for cumulative pain scores over 48 hours. ISB provided better pain relief at 4–8 hours, while opioid use and satisfaction were similar; several complications occurred only in the ISB group.
- SFA was noninferior for cumulative 48-hour pain scores.
- ISB provided better pain relief at 4–8 hours.
- Opioid use and satisfaction were similar between groups.
- The trial included 80 patients with limited diversity.
In this randomized trial, 80 patients undergoing arthroscopic shoulder surgery were assigned to surgeon-performed shoulder field anesthesia (SFA) or interscalene brachial plexus block (ISB). The primary outcome was cumulative numeric rating scale pain over 48 hours, with a prespecified noninferiority margin of 1.5 points. Secondary outcomes included pain at set time points, opioid consumption, satisfaction, length of stay and block-related complications.
SFA met the noninferiority criterion: the reported mean difference in cumulative pain scores was −0.824 (ISB − SFA; 95% CI, −1.853 to 0.206). ISB produced lower pain scores at 4–8 hours, but scores converged thereafter. Opioid consumption, patient satisfaction and oxygen desaturation rates were similar; hospital stay was shorter with SFA. Two cases of Horner syndrome and one respiratory event requiring intensive care occurred in the ISB group, compared with none in the SFA group.
The findings suggest SFA may be an analgesic alternative when avoiding phrenic nerve effects is a consideration, but the small trial and limited participant diversity constrain generalizability. The study reports fewer clinically apparent complications with SFA, but does not establish comparative safety for uncommon events.
In practice
For patients undergoing arthroscopic shoulder surgery, this randomized 80-patient trial found surgeon-performed SFA noninferior to ISB for cumulative pain over 48 hours, with similar opioid use and satisfaction. ISB gave better pain relief at 4–8 hours; the reported Horner syndrome and respiratory event occurred only in that group, and hospital stay was shorter with SFA. These results may inform analgesic choice, but the small sample and limited diversity do not establish safety differences for uncommon complications or broad generalizability.
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The Journal of Bone and Joint Surgery, American Volume: Comparison of Shoulder Field Anesthesia (SFA) with Interscalene Block (ISB) for Analgesia After Arthroscopic Shoulder Surgery ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.