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Abstract
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Background and Aims Arthroscopic shoulder surgeries are associated with moderate/severe pain. In this case series, shoulder PENG (pericapsular nerve group) and superficial cervical plexus nerve block were applied for postoperative analgesia in arthroscopic shoulder surgery. We aimed to evaluate the contribution of the PENG block to perioperative opioid consumption and the analgesic efficacy postoperatively.
Methods Permission was obtained from all patients to present this case series. After induction of standard general anesthesia in 6 ASA I-II adult patients scheduled for elective arthroscopic shoulder surgery, shoulder PENG (17 ml 0.05% bupivacaine and 3 ml saline were prepared with 15 ml) and superficial cervical plexus block (6 ml 2% lidocaine) was applied (figure 1). Anesthesia was maintained with sevoflurane in an oxygen-air (50-50%) mixture and remifentanil intravenous infusion. The dose of remifentanil was adjusted according to the patient‘s needs, considering the hemodynamic parameters. Multimodal analgesia was administered in the perioperative. Intraoperative remifentanil consumption and numerical pain scores (NRS) at the postoperative 1st, 2nd, and 4th hours of the patients who were extubated at the end of the surgery were recorded.
Results The case series included 6 patients (male/female= 2/4; age= 62±3.9; BMI = 26.4±2.8). The surgical duration times were 170±64.4 minutes. Remifentanil consumption was 23±25.4 μg. NRS scores ranged from 1 to 4 (table 1). No pulmonary complications or motor blocks were observed in the patients.
A. Probe position
B. View of the needle tip under the subscapular muscle
Characteristics of the cases and results
Conclusions Ultrasonography-guided shoulder PENG block can provide adequate perioperative analgesia as an alternative to peripheral nerve blocks and reduce opioid consumption in arthroscopic shoulder surgeries.