Coracoid approach brachial plexus block combined with posterior suprascapular nerve block provides analgesia for shoulder arthroscopy: a randomized controlled trial

Shoulder arthroscopy has become a common procedure, but it is often associated with severe postoperative pain. This study aims to evaluate the analgesic effect of ultrasound-guided coracoid approach brachial plexus block combined with posterior suprascapular nerve block in shoulder arthroscopy. To this end, fifty patients undergoing right shoulder arthroscopy were randomly divided into two groups with 25 patients in each group. Before induction of general anesthesia, patients in the two groups received different nerve blocks. In Group A, participants received ultrasound-guided supraclavicular brachial plexus block with 25 mL 0.3% ropivacaine. In Group B, coracoid approach brachial plexus block and posterior suprascapular nerve block were carried out under ultrasound guidance. M-mode ultrasound was used to measure diaphragm movement before and 30 min after the block, and the presence of hemidiaphragm paralysis was recorded during calm breathing and deep breathing. Pain scores were recorded at 1, 6, 12, 24 and 48 h after surgery. The actual press times of the PCA pump and consumption of sufentanil were also recorded.A total of 45 patients completed this study. The incidence of hemidiaphragm paralysis in Group B was significantly lower than that in Group A under both calm breathing and deep breathing. The two groups displayed similar pain scores at 1, 6, 12, 24 and 48 h after surgery. Compared with supraclavicular brachial plexus block, coracoid approach brachial plexus block combined with posterior suprascapular nerve block can significantly reduce the occurrence of hemidiaphragm paralysis with an equivalent postoperative analgesic effect for shoulder arthroscopy. Therefore, the latter may be beneficial for early postoperative recovery in patients who cannot tolerate hemidiaphragm paralysis. Trial registration: This study was registered in the Chinese Clinical Trial Register (ID ChiCTR2100043069) on 04/02/2021.