Comparison of Ultrasound Guided Interscalene Block vs Multimodal Analgesia in Shoulder Arthroscopic Surgeries- Prospective, Randomized Controlled Study

Introduction: Arthroscopic shoulder surgery is common and associated with severe postoperative pain. Interscalene block is recommended as a most effective method to relieve pain but it is also associated with some serious complications and expertise is required. This study assesses the efficacy, quality of analgesia postoperatively and overall satisfaction of patients undergoing shoulder arthroscopy by comparing ultrasound guided interscalene block with intraarticular morphine and local anaesthesia. Methods: This is prospective, single blind, randomized controlled study involving 46 patients randomized in ratio of 1:1 undergoing elective shoulder arthroscopy where GA was given in all patients out of which 23 received ISB before GA and 23 patients received intra articular injection of morphine and lignocaine at end of surgery. VAS score for postoperative pain, opioid consumption, PONV, patient satisfaction and readiness to discharge criteria was observed at 1, 4, 6, 12 and 24 hours post operatively in both groups. Results: In block group patient, VAS score was significantly low at 1 h and 6 h compared to non-block group. At 12 h both the group had a similar VAS score while at 24 h significantly high VAS score found in Block group patient. There was significant difference in opioid consumption in both groups. PONV, Complication rates, Satisfaction score and ready to discharge criteria were comparable in both groups. Conclusion: ISB provides effective analgesia in early postoperative period and it reduces the overall opioid requirement but the rebound pain which occurs after wearing off the block can reduce its overall benefit and satisfaction as compared to other modalities of multimodal analgesia. So, intra articular LA and opioid infiltration provides equivalent benefits in terms of post op analgesia and satisfaction.