Lung Ultrasound Assessment of Diaphragm Sparing Function After Ultrasound Guided Combined Suprascapular/ Axillary Nerve Blocks or Erector Spinae Plain Block for Shoulder Arthroscopy Analgesia A Controlled Comparative Study

Kahla, Ayman Hussein Fahmy; Abd-Elaty, Moaz Atef El-Shahat; El Nagar, Ahmed Mosaad Ahmed; Ibrahim, Ahmed Khedr Tolba

doi:https://doi.org/10.21608/aimj.2025.446671

Lung Ultrasound Assessment of Diaphragm Sparing Function After Ultrasound Guided Combined Suprascapular/ Axillary Nerve Blocks or Erector Spinae Plain Block for Shoulder Arthroscopy Analgesia A Controlled Comparative Study

Document Type : Original Article

Authors

¹ Professor of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

² Assistant Professor of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

³ Lecturer of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

⁴ MSc, Anesthesiology, Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

https://doi.org/10.21608/aimj.2025.446671

Abstract

Background: Shoulder surgery is characterized by relatively high intraoperative and postoperative pain. Reduction in postoperative pain is essential to promote rehabilitation and increase patient satisfaction. Opioid medications are commonly used to reduce postoperative pain; however, they have significant drawbacks, including side effects and possibly leading to dependency.
Aim and objectives: This study aims to compare the diaphragmatic function after a shoulder arthroscopic surgery procedure using ultrasonography of the lungs following an ultrasound-guided combined suprascapular (SSNB) and axillary nerve block (AN) as opposed to an erector spinae plane block (ESPB) or an interscalene brachial plexus block (ISPB).
Subjects and methods: From March 2023 through January 2025, 93 patients on the shoulder arthroscopy waiting list at Al-Azhar University Hospitals in Cairo, Egypt (specifically, Al-Hussein and Bab El-Sharia) were enrolled in this prospective randomized controlled clinical trial.
Results: The ISPB group experienced a significant decrease in heart rate and mean arterial pressure compared to the SSNB+ANB and ESPB groups. As regard the diaphragmatic excursion measurements, which is a key focus of this study, our results indicate that the ISPB group had significantly lower diaphragmatic excursion compared to the SSNB+ANB and ESPB groups.
Conclusion: While ISPB provides superior pain control and reduces opioid consumption, the combined SSNB and ESPB offer advantages in terms of diaphragmatic function preservation and hemodynamic stability.

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