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A Comparison of Combined Suprascapular and Axillary Nerve Blocks to Interscalene Nerve Block for Analgesia in Arthroscopic Shoulder Surgery: An Equivalence Study
  1. Shalini Dhir, MD, FRCPC*,
  2. Rakesh V. Sondekoppam, MD,
  3. Ranjita Sharma, FCANZA,
  4. Sugantha Ganapathy, MD, FRCA, FRCPC* and
  5. George S. Athwal, FRCSC§
  1. From the *Department of Anesthesiology and Perioperative Medicine, St Joseph's Health Care, Western University, London, Ontario; and †Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada; ‡Department of Anesthesia, Royal Hobart Hospital, Hobart, Tasmania, Australia; and §Department of Orthopedics, St Joseph's Health Care, Western University, London, Ontario, Canada
  1. Address correspondence to: Shalini Dhir, MD, FRCPC, Department of Anesthesiology and Perioperative Medicine, SJHC, 268 Grosvenor St, London, Ontario, Canada N6A 4V2 (e-mail:


Background and Objectives The primary objective of this study was to compare the analgesic efficacy of combined suprascapular and axillary nerve block (SSAX) with interscalene block (ISB) after arthroscopic shoulder surgery. Our hypothesis was that ultrasound-guided SSAX would provide postoperative analgesia equivalent to ISB.

Methods Sixty adult patients undergoing arthroscopic shoulder surgery received either SSAX or ISB prior to general anesthesia, in a randomized fashion. Pain scores, satisfaction, and adverse effects were recorded in the recovery room, 6 hours, 24 hours, and 7 days after surgery.

Results Combined suprascapular and axillary nerve block provided nonequivalent analgesia when compared with ISB at different time points postoperatively, except on postoperative day 7. Interscalene block had better mean static pain score in the recovery room (ISB 1.80 [95% confidence interval [CI], 1.10–2.50] vs SSAX 5.45 [95% CI, 4.40–6.49; P < 0.001]). At 24 hours, SSAX had better mean static pain score (ISB 6.35 [95% CI, 5.16–7.54] vs SSAX 3.92 [95% CI, 2.52–5.31]; P = 0.01) with similar satisfaction between the groups.

Conclusions Combined suprascapular and axillary nerve block provides nonequivalent analgesia compared with ISB after arthroscopic shoulder surgery. While SSAX provides better quality pain relief at rest and fewer adverse effects at 24 hours, ISB provides better analgesia in the immediate postoperative period. For arthroscopic shoulder surgery, SSAX can be a clinically acceptable analgesic option with different analgesic profile compared with ISB.

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  • This work was presented in part as a poster at the following meetings: annual meeting of American Society of Regional Anesthesia and Pain Medicine 2013 at Boston, MA; annual meeting of the American Society of Anesthesiologists 2013 at San Francisco, CA; and 14th Asian Australian Congress of Anesthesiologists 2014 at Auckland, New Zealand.

    The authors declare no conflict of interest.

    Registered with clinical NCT 01730573.