Curr Pain Headache Rep. 2025 Dec 29. 30(1):
13
PURPOSE OF REVIEW: Analgesic techniques which provide sufficient post-operative shoulder pain relief while minimizing complications is crucial for helping patients achieve optimal recovery. The interscalene brachial plexus block (ISB) has long been considered the gold standard in terms of providing patients with adequate pain control following shoulder operations. However, ISB's expansive neural blockade poses several potential risks, including delayed sensorimotor rehabilitation to the upper extremity, partial blockade of the cervical sympathetic chain, and, most notably, diaphragmatic paresis, rendering this technique a potential contraindication in patients with respiratory compromise, including chronic lung disease, obesity, sleep apnea, etc. Hence, alternative regional techniques which employ a more localized blockade mechanism, such as the suprascapular nerve block (SSNB), have been examined as a means of circumventing these risks, while still providing comparable pain relief. This narrative review aims to provide an objective comparison of the functional efficacy of each analgesic technique based on parameters of post-operative pain management efficacy, opioid consumption, recovery patterns, technical functionality, and side effect profiles.
RECENT FINDINGS: A comprehensive literature search was conducted and identified randomized controlled trials and meta-analyses which subjected patients to ISB or SSNB for shoulder pain relief and various metrics such as pain scores, opioid consumption, pulmonary function, adverse side effects, functional recovery, and patient satisfaction were evaluated. The consensus is that ISB is slightly more efficacious in relieving pain in the initial post-operative phase, but by 24 h post-operation any differences in pain are largely marginal. No clinically significant differences in long-term opioid consumption, patient satisfaction, or pain control were demonstrated in the world literature. Furthermore, SSNB exhibited significantly lower rates of pulmonary impairment and neurological side effects as well as quicker rates of functional recovery.
SUMMARY: While ISB appears to be slightly more efficacious in administering pain relief in the immediate post-operative phase, SSNB appears to provide a safer side effect profile and should be considered in analgesia protocols for shoulder surgeries, especially in patient populations with pre-existing pulmonary conditions.
Keywords: Interscalene brachial plexus block (ISB); Phrenic nerve injury; Postoperative shoulder pain; Regional anesthesia techniques; Shoulder surgery; Suprascapular nerve block (SSNB)