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OP039 Superior trunk block is an effective phrenic-sparing alternative to interscalene block for shoulder arthroscopy: a systematic review and meta-analysis
  1. Sara Amaral1,
  2. Rafael Lombardi2,
  3. Heitor Medeiros3,
  4. Allêh Nogueira4 and
  5. Jeffrey Gadsden5
  1. 1Anaesthesiology, Araranguá, Brazil
  2. 2Anaesthesiology, University of Nebraska Medical Center, Omaha, USA
  3. 3Anaesthesiology, Hospital Universitário Onofre Lopes, Natal, Brazil
  4. 4Anaesthesiology, Escola Bahiana de Medicina e Saúde Pública , Salvador, Brazil
  5. 5Anaesthesiology, Duke University, Durham, USA


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Background and Aims The Superior Trunk Block (STB) is being considered as an alternative to Interscalene Block (ISB) for shoulder arthroscopy. This study aims to compare efficacy and safety between these techniques.

Methods PubMed, EMBASE, Scopus and Cochrane were searched for randomized controlled trials (RCTs) comparing the STB to the ISB for shoulder arthroscopies. Outcomes assessed included incidence and extent of hemidiaphragmatic paralysis, pain scores, opioid consumption, patient satisfaction, block duration, and block-related complications. RevMan 5.4 analyzed data. Risk of bias was appraised using the RoB-2 tool.

Results We analyzed 4 RCTs involving 359 patients, of whom 49.5% underwent STB. The results showed that STB resulted in less total hemidiaphragmatic paralysis (figure 2), less subjective dyspnea (figure 3) and lower incidence of Horner’s Syndrome (RR 0.06; 95% CI 0.01 to 0.32; p < 0.001; I2 = 0%, 3 RCTs, 221 patients). No statistically significant differences were found between the two groups for other outcomes, except for pain score at rest at 24h, which was favorable to STB (MD -0.75; 95% CI -1.35 to -0.15; p = 0.01). However, we should consider the clinical relevance of this difference. Our study represents the largest sample size available comparing these techniques, and our results indicate that probably there was enough statistical power for the majority of outcomes analyzed.

Abstract OP039 Figure 1

The STB demonstrated less total hemidiaphragmatic paralysis (1A), and an increased absence of hemidiaphragmatic paralysis (1B) than the ISB

Abstract OP039 Figure 2

There was a significantly better diaphragmatic excursion 30 minutes after the STB than the ISB

Abstract OP039 Figure 3

There was significantly less subjective dyspnea in the STB group when compared to the ISB

Conclusions Our findings suggest that STB is safer than ISB, as it results in a lower incidence and extent of hemidiaphragmatic paralysis, while demonstrating similar block efficacy.

  • superior trunk block
  • interscalene block
  • shoulder surgery
  • meta-analysis

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