ULTRASOUND-GUIDED PHRENIC NERVE- PRESERVING REGIONAL BLOCKS, COMBINED INFRACLAVICULAR AND SUPRASCAPULAR NERVE BLOCK

Abstract

Background: Effective postoperative pain control after shoulder surgery is essential for early recovery and patient satisfaction. Ultrasound-guided peripheral nerve blocks play an important role in multimodal analgesia by providing targeted pain relief with an acceptable safety profile. The combined use of infraclavicular brachial plexus block and suprascapular nerve block addresses the major sensory innervation of the shoulder joint and surrounding structures. The aim is to evaluate the analgesic efficacy, block characteristics, postoperative analgesic requirements, and safety of ultrasound-guided combined infraclavicular brachial plexus block and suprascapular nerve block in patients undergoing elective shoulder surgery under general anesthesia. Materials and Methods: This prospective observational study was conducted in the Department of Anesthesiology and Critical Care, Government Medical College, Srinagar, over an 18-month period (September 2022 to March 2024). Forty-nine adult patients aged 18–65 years, belonging to ASA physical status I–II, scheduled for elective shoulder surgery under general anesthesia were included. All patients received an ultrasound-guided suprascapular nerve block with 4 ml of 0.5% ropivacaine followed by an ultrasound-guided infraclavicular brachial plexus block with 15 ml of 0.5% ropivacaine. Parameters assessed included time to perform the block, onset of sensory and motor blockade, postoperative pain scores using the visual analogue scale (VAS), rescue analgesic requirement within 24 hours, patient satisfaction, and block-related complications. Results: The mean time required to perform the combined block was 9.41 ± 5.38 minutes. Sensory blockade onset occurred at a mean of 9.81 ± 1.02 minutes, while motor blockade onset was observed at 11.78 ± 2.31 minutes. Effective postoperative analgesia was achieved, with low VAS pain scores maintained during the first 24 hours after surgery and delayed requirement for rescue analgesia. Most patients required minimal rescue analgesia within 24 hours. Patient satisfaction with postoperative pain control was high, with the majority rating analgesia as excellent or very good. No major block-related complications such as pneumothorax, accidental vascular puncture, hematoma, or persistent neurological deficits were noted. Conclusion: Ultrasound-guided combined infraclavicular brachial plexus block and suprascapular nerve block provides effective and sustained postoperative analgesia for shoulder surgeries, with favorable block characteristics, reduced rescue analgesic requirement, high patient satisfaction, and a good safety profile.