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A Comparison of Costoclavicular Block and Interscalene Block for Pain Relief after Arthroscopic Shoulder Surgery
Introduction Interscalene block (ISB) is commonly used for efficient pain relief after arthroscopic shoulder surgery. But, it is linked with a greater occurrence of unilateral diaphragmatic paralysis (UDP). This may add to patient dissatisfaction and also may not be tolerated well by patients having respiratory diseases. We have compared the efficacy of costoclavicular block (CCB) with ISB for postoperative analgesia in patients undergoing arthroscopic shoulder surgery.
Materials and Methods Fifty patients were divided into two groups of 25 each (ISB or CCB group). In total, 20 mL of 0.5% levobupivacaine along with 4 mg of dexamethasone as adjuvant was used during both ultrasound-guided ISB and CCB. Numerical rating scale (NRS) scores for pain were assessed at 0, 0.5, 1, 2, 3, 6, 12, and 24 hours in postoperative period. The mean onset time of block, time of first painkiller demand, total painkiller demand for 24 hours postoperatively, patient wellbeing, incidence of UDP, and any other complications were recorded.
Results NRS pain scores in both groups at 0, 0.5, 1, 2, 3, 6, 12, and 24 hours were comparable. (p > 0.05) Mean onset time of block was earlier in ISB group contrary to CCB group (p < 0.05). There was higher occurrence of UDP in ISB group contrary to CCB group (p < 0.05). There was no notable variation regarding the time of first painkiller demand and total painkiller demand in the first 24 hours. Patients were more satisfied in CCB group contrary to ISB group.
Conclusion As CCB provided equivalent analgesia in postoperative period like ISB without any risk of UDP, it can be a better substitute to ISB for pain relief in arthroscopic shoulder surgery.
Keywordsinterscalene block - costoclavicular block - postoperative pain - shoulder surgery - arthroscopy
16 August 2021 (online)
© 2021. Medical and Surgical Update Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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