A Comparative Study between the Analgesic Efficacy of Ultrasound Guided Interscalene Block vs General Anesthesia in Patients Undergoing Shoulder Arthroscopy

Abstract Background Shoulder arthroscopy can effectively treat a number of injuries and diseases of the shoulder on an ambulatory basis. Although shoulder arthroscopy is considered minimally invasive, it is associated with severe intraoperative and postoperative pain. Hence, it requires adequate analgesia and muscle relaxation for the procedure. For shoulder arthroscopy, regional anesthesia is better than general anesthesia (GA) because of the extended postoperative analgesia and rapid recovery towards discharge. Aim of the Work to compare the analgesic efficacy of ultrasound guided Interscalene block alone without GA VS general anesthesia as regards the postoperative pain management, analgesics requirements and hospital stay during shoulder arthroscopy. Patients and Methods Type of Study: a prospective, randomized, comparative study. Study Setting: After obtaining approval from the Research Ethical Committee of Ain Shams University, this study will be conducted in the operating theatres of Ain Shams University Hospitals. Study Period: Six months (started from FEB. 2023 to AUG. 2023). Results In our study, regarding VAS score among the studied patients, The pain threshold score using VAS score at different times postoperatively showed non-significant difference between the ISB all times, with p-values <0.001 for VAS 1, VAS 6, VAS 12, VAS 18 except at VAS 24 HR a significant difference at p value 0.887 was found but still the VAS score was less than 4, So, no pain killers were given. Surprisingly a reported improvement in expression of postoperative pain was noticed later on. This is may be due to the very dense block offered by interscalene brachial plexus block. Regarding the assessment of patient„s vital data represented in the heart rate and mean arterial blood pressure our study shows highly statistically significant higher mean in group G compared to group I according to heart rate from at0hr to after 20hrs with p-value <0.05, while after 24hrs insignificant with p-value >0.05 NS with almost the same results for mean arterial blood pressure. Our study demonstrates that ISB provides a better hemodynamic stability postoperatively regarding the control of heart rate avoiding the unwanted catastrophic tachycardia and lower mean arterial blood pressure while maintain adequate desirable tissue perfusion without the need of toxic mega opioid rescue doses. Conclusion Ultrasound guided ISB for shoulders arthroscopic surgical operation provides greater pain-free period, lesser opioid requirement, and lesser PACU stay duration in patients receiving this block