Comparison of Interscalene Brachial Plexus, Anterior Suprascapular Nerve, and Costoclavicular Brachial Plexus Blocks in Arthroscopic Shoulder Surgery: A Prospective Observational Study

Background: Interscalene brachial plexus block (ISB) remains gold standard anesthesia method in shoulder surgery. However, risk of diaphragm paralysis is themajor concern among anesthesiologists. Recent studies on anterior suprascapular nerve block (ASB) and costoclavicular brachial plexus block (CCB) have given promising results for preventing diaphragm paralysis and providing sufficient analgesia. Materials and Methods: Forty-six patients who underwent arthroscopic shoulder surgery under one of three regional anesthesia techniques, including ISB (n = 15), ASB (n = 15), and CCB (n = 16), were included in the study. Diaphragmatic excursion was measured by ultrasonography 30th minutes after block. Postoperative pain was assessed with a numerical rating scale. The groups were compared between each other in terms of diaphragm paralysis and postoperative pain status. Results: The groups were similar in basic patient and surgical characteristics, motor and sensory block scores. There was no difference in analgesic use between the groups. Diaphragm measurements in the ISB group were found significantly lower compared to the ASB and CCB groups (p < 0.001). In addition, diaphragm measurements in the ASB group were found lower than in the CCB group (p = 0.036). When compared diaphragm measurements between the initial and 30th minute of block, significant decreases were observed in the ISB and ASB groups (p < 0.001) whereas no difference was found in the CCB group. Conclusions: Postoperative pain scores and analgesic use were similar between there blocks. In terms of diaphragm paralysis, the best blocks were CCB followed by ASB. CCB and ASB can be considered as safe and effective alternative blocks in arthroscopic shoulder surgery.