Awake Interscalene Block Associated With Altered Perioperative Biomarker Responses and Lower Wound-Related Symptom Burden After Open Rotator Cuff Repair

Background:This exploratory randomized trial evaluated whether awake interscalene brachial plexus block (ISB) is associated with lower wound-related symptom burden and altered perioperative biomarker responses compared with general anesthesia (GA) in patients undergoing open rotator cuff repair. Material/Methods:Thirty-four patients were randomized to ultrasound-guided ISB (n = 17) or GA (n = 17).Two patients in the GA group were excluded from per-protocol analysis, leaving 15 GA and 17 ISB patients.The primary outcome was the Toronto Symptom Assessment System for Wounds (TSAS-W) score on postoperative days 5 and 14.Secondary outcomes included serum interleukin-1beta, interleukin-2, tumor necrosis factor-alpha, epidermal growth factor, platelet-derived growth factor, and transforming growth factor-beta, platelet counts, postoperative pain scores, opioid consumption, mobilization time, and postoperative nausea and vomiting.TSAS-W is not validated for acute shoulder incisions. Results:TSAS-W scores were lower in the ISB group on postoperative day 5 (median 44 vs 60, P = 0.001) and day 14 (median 32 vs 54, P = 0.004).ISB was associated with altered postoperative biomarker patterns in unadjusted analyses.In a post hoc sensitivity analysis including randomized participants (GA n = 17, ISB n = 17), the difference remained significant (day 5: P = 0.021; day 14: P = 0.034).Pain scores and opioid consumption were lower, mobilization was earlier, and nausea and vomiting were less frequent (all P < 0.001). Conclusions:Awake ISB was associated with lower TSAS-W scores and altered perioperative biomarker responses after open rotator cuff repair.These findings are hypothesis-generating and require confirmation in adequately powered studies using validated postoperative outcome measures.