Efficacy of analgesics in patients undergoing arthroscopic repair of rotator cuff at Gujarat Adani institute of medical science, Bhuj, Kutch, Gujarat

Abhinav Kotak, Suresh Rudani


Background: To evaluate analgesic efficacy when catheters are positioned with assistance of arthroscope to block suprascapular and axillary nerves in patients undergoing arthroscopic repair of rotator cuff under general anesthesia.

Methods: Present study was performed at department of orthopedics, Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. 24 patients who experienced arthroscopic repair of rotator cuff between July 2015 and October 2015 were catheterized to block suprascapular and axillary nerves through shoulder arthroscopy were incorporated in the study. Clinical outcomes were assessed using visual analog scale (VAS) scores preoperatively and at 0 h, 6 h, 12 h, 18 h, 24 h, and postoperative day 2.

Results: Preoperative and postoperative 0 h, 6 h, 12 h, 18 h, 24 h, and day 2 mean VAS scores were 6.37±0.91, 0.45±0.39, 0.59±0.40, 0.62±0.39, 0.61±0.42, 0.51±0.35, and 1.54±0.50, respectively. No statistical difference was found among 0 h, 6 h, 12 h, 18 h, and 24 h time points; however, assessment of postoperative day 2 and postoperative 0 h, 6 h, 12 h, 18h and 24 h VAS scores showed statistically significant difference (P <0.05). All patients were discharged at the end of 24 h with no complication. The mean time (in minutes) required for blocking suprascapular nerve and axillar nerve were 14.38±3.21 and 3.75±0.85, respectively.

Conclusions: These results confirmed that blocking two nerves with arthroscopic approach was an excellent pain management method in postoperative period. Accordingly, patients could recover rapidly and patients’ satisfaction could be improved.



Arthroscopic, Bhuj, Catheters, Visual analog scale

Full Text:



Yamakado K. Efficacy of arthroscopically placed pain catheter adjacent to the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block) following arthroscopic rotator‑cuff repair. Open Access J Sports Med. 2014;5:129-36.

Boss AP, Maurer T, Seiler S, Aeschbach A, Hintermann B, Strebel S. Continuous subacromial bupivacaine infusion for postoperative analgesia after open acromioplasty and rotator cuff repair: Preliminary results. J Shoulder Elbow Surg. 2004;13:630-4.

Jerosch J, Saad M, Greig M, Filler T. Suprascapular nerve block as a method of preemptive pain control in shoulder surgery. Knee Surg Sports Traumatol Arthrosc. 2008;16:602-7.

Checcucci G, Allegra A, Bigazzi P, Gianesello L, Ceruso M, Gritti G. A new technique for regional anesthesia for arthroscopic shoulder surgery based on a suprascapular nerve block and an axillary nerve block: An evaluation of the first results. Arthroscopy. 2008;24:689-96.

Nam YS, Jeong JJ, Han SH, Park SE, Lee SM, Kwon MJ, et al. An anatomic and clinical study of the suprascapular and axillary nerve blocks for shoulder arthroscopy. J Shoulder Elbow Surg. 2011;20:1061-8.

Matsumoto D, Suenaga N, Oizumi N, Hisada Y, Minami A. A new nerve block procedure for the suprascapular nerve based on a cadaveric study. J Shoulder Elbow Surg. 2009;18:607-11.

Ritchie ED, Tong D, Chung F, Norris AM, Miniaci A, Vairavanathan SD. Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: A new modality? Anesth Analg. 1997;84:1306-12.

Lafosse L, Tomasi A, Corbett S, Baier G, Willems K, Gobezie R. Arthroscopic release of suprascapular nerve entrapment at the suprascapular notch: Technique and preliminary results. Arthroscopy. 2007;23:34-42.

Moote CA. The prevention of postoperative pain. Can J Anaesth. 1994;41:527-33.

Henn P, Steuer K, Fischer A, Fischer M. Effectiveness of morphine by periarticular injections after shoulder arthroscopy. Anaesthesist. 2000;49:721-4.

Scoggin JF 3rd, Mayfield G, Awaya DJ, Pi M, Prentiss J, Takahashi J. Subacromial and intra‑articular morphine versus bupivacaine after shoulder arthroscopy. Arthroscopy. 2002;18:464-8.

Al‑Kaisy A, McGuire G, Chan VW, Bruin G, Peng P, Miniaci A, et al. Analgesic effect of interscalene block using low‑dose bupivacaine for outpatient arthroscopic shoulder surgery. Reg Anesth Pain Med. 1998;23:469-73.

Brown AR, Weiss R, Greenberg C, Flatow EL, Bigliani LU. Interscalene block for shoulder arthroscopy: Comparison with general anesthesia. Arthroscopy. 1993;9:295-300.

Wurm WH, Concepcion M, Sternlicht A, Carabuena JM, Robelen G, Goudas LC, et al. Preoperative interscalene block for elective shoulder surgery: Loss of benefit over early postoperative block after patient discharge to home. Anesth Analg. 2003;97:1620-6.

Aszmann OC, Dellon AL, Birely BT, McFarland EG. Innervation of the human shoulder joint and its implications for surgery. Clin Orthop Relat Res. 1996;330:202-7.

Greiner A, Golser K, Wambacher M, Kralinger F, Sperner G. The course of the suprascapular nerve in the supraspinatus fossa and its vulnerability in muscle advancement. J Shoulder Elbow Surg. 2003;12:256-9.

Tubbs RS, Smyth MD, Salter G, Oakes WJ. Anomalous traversement of the suprascapular artery through the suprascapular notch: A possible mechanism for undiagnosed shoulder pain? Med Sci Monit. 2003;9:116-9.

Chan CW, Peng PW. Suprascapular nerve block: A narrative review. Reg Anesth Pain Med. 2011;36:358-73.

Uz A, Apaydin N, Bozkurt M, Elhan A. The anatomic branch pattern of the axillary nerve. J Shoulder Elbow Surg. 2007;16:240-4.

Uno A, Bain GI, Mehta JA. Arthroscopic relationship of the axillary nerve to the shoulder joint capsule: An anatomic study. J Shoulder Elbow Surg. 1999;8:226-30.

Eakin CL, Dvirnak P, Miller CM, Hawkins RJ. The relationship of the axillary nerve to arthroscopically placed capsulolabral sutures. An anatomic study. Am J Sports Med. 1998;26:50-9.

Price MR, Tillett ED, Acland RD, Nettleton GS. Determining the relationship of the axillary nerve to the shoulder joint capsule from an arthroscopic perspective. J Bone Joint Surg Am. 2004;86:2135-42.

Bryan WJ, Schauder K, Tullos HS. The axillary nerve and its relationship to common sports medicine shoulder procedures. Am J Sports Med. 1986;14:113-6.

Sahu D, Fullick R, Lafosse L. Arthroscopic treatment of suprascapular nerve neuropathy. In: Steele C, editor. Applications of EMG in Clinical and Sports Medicine. Rijeka: InTech; 2012: 225-40.

Ferraro LH, Takeda A, dos Reis Falcão LF, Rezende AH, Sadatsune EJ, Tardelli MA. Determination of the minimum effective volume of 0.5% bupivacaine for ultrasound‑guided axillary brachial plexus block. Braz J Anesthesiol. 2014;64:49-53.

Feigl GC, Anderhuber F, Dorn C, Pipam W, Rosmarin W, Likar R. Modified lateral block of the suprascapular nerve: A safe approach and how much to inject? A morphological study. Reg Anesth Pain Med. 2007;32:488-94.