Interscalene Block Versus Anterior Suprascapular Block for Post-Thoracotomy Shoulder Pain

Interscalene Block Versus Anterior Suprascapular Block for Post-Thoracotomy Shoulder Pain: A Randomized Controlled Trial

This study aims to compare the frequency of occurrence of ipsilateral shoulder pain in patients undergoing thoracotomy with ultrasound-guided interscalene block, anterior suprascapular block as adjunct to epidural and epidural block only.

Thoracotomy is one type of surgery associated with challenging pain that needs to be promptly addressed to avoid post-operative respiratory complications and aid in effective postoperative physiotherapy and patient recovery. Epidural analgesia is considered the gold standard for the thoracotomy procedure. Ipsilateral shoulder pain (ISP) following thoracotomy has an incidence ranging from 37% to 85%.

Being so common, this pain needs more attention and proper anticipation, and management. ISP is usually non-responsive to the effects of epidural and paravertebral blocks.

Inclusion Criteria:

• Age > 18 years and ≤ 65 years old.
• American Society of Anesthesiologists (ASA) physical status II-III.
• Body mass index 18-35 kg/m2.
• Patients who have a confirmed diagnosis of lung cancer and are scheduled for elective open-lung surgery.

Exclusion Criteria:

• Allergy to local anesthetics.
• Known psychiatric or neurologic disorders.
• Alcohol or narcotics abuse.
• Contraindications to thoracic epidural or suprascapular block, or interscalene block, e.g., coagulopathy or local infection.
• Pre-existing shoulder symptoms.
• History of previous thoracotomy.
• Severe restrictive or obstructive pulmonary disease.
• Pre-existing contralateral diaphragmatic paralysis.