Suprascapular Nerve Block for Postoperative Pain Control in Shoulder Arthroscopic Surgery: A Randomized Control Trial

Jomaa Mohammad

Department of Orthopedic Surgery, Lebanese University, Hadath, Lebanon.

Nasserdine Ali

Department of Orthopedic Surgery, Université Paris Cité, Paris, France.

Nader Fadi *

Department of Orthopedic Surgery, Université Paris Cité, Paris, France.

Bassil Georges

Department of Orthopedic Surgery, Lebanese University, Hadath, Lebanon.

Noureddine El Moussaoui Zahraa

Department of Neurology, Lebanese University, Hadath, Lebanon.

Kourtian Vatche

Department of Orthopedic Surgery, The Lebanese Hospital Geitaoui-University Medical Center, Lebanon.

*Author to whom correspondence should be addressed.


Background: Arthroscopic shoulder surgery is known to cause severe postoperative pain. We conducted a randomized control trial to evaluate the efficacy of suprascapular nerve block (SSB) in the reduction of this pain and the increase of patient satisfaction. 

Methods: 34 patients undergoing arthroscopic shoulder surgery under general anesthesia were prospectively randomized into two groups: 20 patients received suprascapular nerve block (SSB)  and 14 patients received placebo (control group). Patient pain levels were measured using the numerical rating scale (NRS) in the recovery room, 2-4 hours, and 24 h after surgery. Analgesic and opioid consumption was evaluated during the first 24 hours. Patient satisfaction was assessed at 48 hours post-operatively.

Results: compared to the control group, the SSN group reported significantly lower levels of postoperative pain in the recovery room (3.2 vs. 7.7), 2-4 hours postoperatively (3.6 vs. 7.6) and at 24 hours post-operatively (5.35 vs. 7.2). Also, SSB patients required significantly less analgesic (60% requiring 1-2 ampoules vs. 83% requiring 2-3 ampoules) and no opioids at all (0% vs. 14.3%). They had higher levels of postoperative satisfaction (1.55 vs. 0.6).

Conclusion: Patients treated with suprascapular block had less pain during the first 24 hours after surgery, which led to a decreased need for analgesics. Furthermore, patients were significantly more satisfied with the operation. We conclude that SSB may be an effective modality for post-operative analgesia.

Level of Evidence: Prospective, randomized, double-blinded clinical trial, Level I evidence

Keywords: Suprascapular, nerve block, shoulder, arthroscopy, post-operative analgesia

How to Cite

Mohammad , J., Ali , N., Fadi , N., Georges , B., Zahraa , N. E. M., & Vatche, K. (2023). Suprascapular Nerve Block for Postoperative Pain Control in Shoulder Arthroscopic Surgery: A Randomized Control Trial. Asian Journal of Orthopaedic Research, 6(2), 120–131. Retrieved from


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Fontana C, Di Donato A, Di Giacomo G, Costantini A, De Vita A, Lancia F, Caricati A. Postoperative analgesia for arthroscopic shoulder surgery: A prospective randomized controlled study of intraarticular, subacromial injection, interscalenic brachial plexus block and intraarticular plus subacromial injection efficacy, Eur. J. Anaesthesiol. 2009;26: 689–693. Available:

Drosos G, Stavropoulos N, Katsis A, Kesidis K, Kazakos K, Verettas DA. Post-Operative Pain After Knee Arthroscopy and Related Factors, Open Orthop. J. 2008;2:110–114. Available:

Stiglitz Y, Gosselin O, Sedaghatian J, F Sirveaux, Molé D. Pain after shoulder arthroscopy: A prospective study on 231 cases., Orthop. Traumatol. Surg. Res. 2011;97:260–6. Available:

J Orthop. 2020 May-Jun;19:28–30.

Published online 2019 Nov 21. DOI: 10.1016/j.jor.2019.11.013 PMCID: PMC6994801PMID: 32021031

Boss AP, Maurer T, Seiler S, Aeschbach A, Hintermann B, Strebel S. Continuous subacromial bupivacaine infusion for postoperative analgesia after open acromioplasty and rotator cuff repair: Preliminary results, J. Shoulder Elb. Surg. 2004;13:630–634. Available:

Barber FA. Suprascapular Nerve Block for Shoulder Arthroscopy, Arthrosc. J. Arthrosc. Relat. Surg. 2005;21:1015.e1-1015.e4. Available:

Scoggin JF, Mayfield G, Awaya DJ, Pi M, Prentiss J, Takahashi J. Subacromial and intra-articular morphine versus bupivacaine after shoulder arthroscopy, Arthrosc. J. Arthrosc. Relat. Surg. 2002;18:464– 468. Available:

Ritchie ED, Tong D, Chung F, Norris AM, Miniaci A, Vairavanathan SD. Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: A new modality?, Anesth. Analg. 1997;84:1306–12. Available:

Al-Kaisy A, McGuire G, Chan VW, Bruin G, Peng P, Miniaci A, Perlas A. Analgesic effect of interscalene block using low-dose bupivacaine for outpatient arthroscopic shoulder surgery., Reg. Anesth. Pain Med. 23 (n.d.) 469–73. Available:

Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, Glaser SE, Vallejo R. Opioid complications and side effects., Pain Physician. 2008;11:S105-20. Available:

Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia., Pain Physician. 14(n.d.):145–61. Available:

Hadzic A, Williams BA, Karaca PE, Hobeika P, Unis G, Dermksian J, et al. For Outpatient Rotator Cuff Surgery, Nerve Block Anesthesia Provides Superior Same-day Recovery over General Anesthesia, Anesthesiology. 2005;102:1001–1007. Available:

Laurila PA, Löppönen A, Kangas-Saarela T, Flinkkilä T, Salomäki TE. Interscalene brachial plexus block is superior to subacromial bursa block after arthroscopic shoulder surgery, Acta Anaesthesiol. Scand. 2002;46:1031–1036. Available:

Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: A critical appraisal and review of current techniques, Anaesthesia. 2010;65: 608–624. Available:

Singelyn FJ, Lhotel L, Fabre B, Pain Relief After Arthroscopic Shoulder Surgery: A Comparison of Intraarticular Analgesia, Suprascapular Nerve Block, and Interscalene Brachial Plexus Block, Anesth. Analg. 2004;589–592. Available:

Kay J, Memon M, Hu T, Simunovic N, Duong A, Paul J, et al. Suprascapular Nerve Blockade for Postoperative Pain Control After Arthroscopic Shoulder Surgery: A Systematic Review and Meta-analysis, Orthop. J. Sport. Med. 2018; 6:232596711881585. Available:

Fujimura N, Namba H, Tsunoda K, Kawamata T, Taki K, Igarasi M, Namiki A. Effect of Hemidiaphragmatic Paresis Caused by Interscalene Brachial Plexus Block on Breathing Pattern, Chest Wall Mechanics, and Arterial Blood Gases, Anesth. Analg. 1995;81:962–966. Available:

Aliste J, Bravo D, Finlayson RJ, Tran DQ. A randomized comparison between interscalene and combined infraclavicular-suprascapular blocks for arthroscopic shoulder surgery, Can. J. Anesth. Can. d’anesthésie. 2018;65:280–287. Available:

Urmey WF, Talts KH, Sharrock NE. One Hundred Percent Incidence of Hemidiaphragmatic Paresis Associated With Interscalene Brachial Plexus Anesthesia as Diagnosed by Ultrasonography, Anesth. Analg. 1991;72: 498???503. Available:

Walton J. Complete brachial plexus palsy after total shoulder arthroplasty done with interscalene block anesthesia, Reg. Anesth. Pain Med. 2000;25:318–321. Available:

Barutell C, Vidal F, Raich M, Montero A. A neurological complication following interscalene brachial plexus block, Anaesthesia. 1980;35:365–367. Available:

Tetzlaff JE, Dilger J, Yap E, Brems J, Idiopathic Brachial Plexitis After Total Shoulder Replacement with Interscalene Brachial Plexus Block, Anesth. Analg. 1997;85:644–646. Available:

Passannante AN. Spinal Anesthesia and Permanent Neurologic Deficit After Interscalene Block, Anesth. Analg. 1996; 82:873–874. Available:

Mahoudeau G, Gaertner E, Launoy A, Ocquidant P, Loewenthal A. Bloc interscalénique : cathétérisation accidentelle de l’espace péridural, Ann. Fr. Anesth. Reanim. 1995;14:738–441. Available:

Korman B, Riley RH, Convulsions Induced by Ropivacaine During Interscalene Brachial Plexus Block, Anesth. Analg. 1998;87:497. Available:

Candido KD, Sukhani R, Doty R, Nader A, Kendall MC, Yaghmour E, et al. Neurologic Sequelae After Interscalene Brachial Plexus Block for Shoulder/Upper Arm Surgery: The Association of Patient, Anesthetic, and Surgical Factors to the Incidence and Clinical Course, Anesth. Analg. 2005;100:1489–1495. Available:

Webb BG, Sallay PI, McMurray SD, Misamore GW. Comparison of Interscalene Brachial Plexus Block Performed With and Without Steroids, Orthopedics. 2016;39:e1100–e1103. Available:

Misamore G, Webb B, McMurray S, Sallay P. A prospective analysis of interscalene brachial plexus blocks performed under general anesthesia, J. Shoulder Elb. Surg. 2011;20:308–314. Available:

Borgeat A, Ekatodramis G, Kalberer F, Benz C. Acute and Nonacute Complications Associated with Interscalene Block and Shoulder Surgery, Anesthesiology. 2001;95:875–880. Available:

Krone S, Analgesic effects of low-dose ropivacaine for interscalene brachial plexus block for outpatient shoulder surgery—A dose-finding study, Reg. Anesth. Pain Med. 2001;26:439–443. Available:

Lenters TR, Davies J, Matsen FA, The types and severity of complications associated with interscalene brachial plexus block anesthesia: Local and national evidence, J. Shoulder Elb. Surg. 2007;16:379–387. Available:

Weber SC, Jain R. Scalene regional anesthesia for shoulder surgery in a community setting, J. Bone Jt. Surgery-American. 2002;84:775–779. Available:

Robaux S, Bouaziz H, Boisseau N, Raucoules-Aimé M, Laxenaire MC. Persistent Phrenic Nerve Paralysis following Interscalene Brachial Plexus Block, Anesthesiology. 2001;95:1519–1521. Available:

Sun C, Zhang X, Ji X, Yu P, Cai X, Yang H. Suprascapular nerve block and axillary nerve block versus interscalene nerve block for arthroscopic shoulder surgery: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2021 Nov 5;100(44):e27661. DOI: 10.1097/MD.0000000000027661 PMID: 34871240; PMCID: PMC8568401.

Zhao J, Xu N, Li J, Liang G, Zeng L, Luo M, Pan J, Yang W, Liu J. Efficacy and safety of suprascapular nerve block combined with axillary nerve block for arthroscopic shoulder surgery: A systematic review and meta-analysis of randomized controlled trials. Int J Surg. 2021 Oct;94:106111. DOI: 10.1016/j.ijsu.2021.106111 Epub 2021 Sep 11. PMID: 34520842.

Schwartzberg RS, Reuss BL, Rust R. Efficacy of continuous subacromial bupivacaine infusion for pain control after arthroscopic rotator cuff repair, J. Shoulder Elb. Surg. 2013;22:1320– 1324. Available:

Wiater BP, Neradilek MB, Polissar NL, Matsen FA. Risk Factors for Chondrolysis of the Glenohumeral Joint, J. Bone Jt. Surg. 93 (2011) 615–625. Available:

Price D. Axillary (Circumflex) Nerve Block Used in Association With Suprascapular Nerve Block for the Control of Pain Following Total Shoulder Joint Replacement, Reg. Anesth. Pain Med. 2008;33:280–281. Available:

Anakwenze OA, Hosalkar H, Huffman RG. Case Reports: Two Cases of Glenohumeral Chondrolysis after Intraarticular Pain Pumps, Clin. Orthop. Relat. Res. 2010;468:2545–2549. Available:

Busfield BT, Romero DM. Pain pump use after shoulder arthroscopy as a cause of Glenohumeral Chondrolysis, Arthrosc. J. Arthrosc. Relat. Surg. 2009;25:647–652. Available:

Hansen BP, Beck CL, Beck EP, Townsley RW. Postarthroscopic Glenohumeral Chondrolysis, Am. J. Sports Med. 2007;35:1628–1634. Available:

Gomoll AH, Kang RW, Williams JM, Bach BR, Cole BJ, Chondrolysis After Continuous Intra-Articular Bupivacaine Infusion: An Experimental Model Investigating Chondrotoxicity in the Rabbit Shoulder, Arthrosc. J. Arthrosc. Relat. Surg. 2006;22:813–819. Available:

Gomoll AH, Yanke AB, Kang RW, Chubinskaya S, Williams JM, Bach BR, Cole BJ. Long-Term Effects of Bupivacaine on Cartilage in a Rabbit Shoulder Model, Am. J. Sports Med. 2009;37:72–77. Available:

Chan C, Peng PWH, Suprascapular Nerve Block, Reg. Anesth. Pain Med. 2011; 36:358–373. Available:

Park JY, Bang JY, Oh KS. Blind suprascapular and axillary nerve block for post-operative pain in arthroscopic rotator cuff surgery, Knee Surgery, Sport. Traumatol. Arthrosc. 2016;24:3877–3883. Available:

Schoenherr JW, Flynn DN, Doyal A. Suprascapular Nerve Block. 2023 Apr 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 35593863.

Jeske HC, Kralinger F, Wambacher M, Perwanger F, Schoepf R, Oberladstaetter J, et al. A Randomized Study of the Effectiveness of Suprascapular Nerve Block in Patient Satisfaction and Outcome after Arthroscopic Subacromial Decompression, Arthrosc. J. Arthrosc. Relat. Surg. 2011;27:1323–1328. Available:

Ikemoto RY, Murachovsky J, Prata Nascimento LG, Bueno RS, Oliveira Almeida LH, Strose E, et al. Prospective randomized study comparing two anesthetic methods for shoulder surgery, Rev. Bras. Ortop. English Ed. 2010; 45:395–399. Available:

Lee JJ, Yoo YS, Hwang JT, Kim DY, Jeon SJ, S.M. Hwang, J.S. Jang, Efficacy of direct arthroscopy-guided suprascapular nerve block after arthroscopic rotator cuff repair: A prospective randomized study, Knee Surgery, Sport. Traumatol. Arthrosc. 2015;23:562–566. Available:

Ovesen J, Falstie-Jensen T, Christensen C, A Comparison of Subacromial Bursae Block, Suprascapular Nerve Block and Interscalene Brachial Plexus Block after Arthroscopic Shoulder Surgery, Pain Stud. Treat. 2014;02:107–112. Available:

Auyong DB, Hanson NA, Joseph RS, Schmidt BE, Slee AE, Yuan SC. Comparison of Anterior Suprascapular, Supraclavicular, and Interscalene Nerve Block Approaches for Major Outpatient Arthroscopic Shoulder Surgery: A Randomized, Double-blind, Noninferiority Trial. Anesthesiology. 2018 Jul;129(1):47-57. DOI: 10.1097/ALN.0000000000002208 PMID: 29634491.

Chiarotto A, Boers M, Deyo RA, Buchbinder R, Corbin TP, Costa LOP, et al. Core outcome measurement instruments for clinical trials in nonspecific low back pain, Pain. 2018;159:481– 495. Available:

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF, Arthritis Care Res. (Hoboken). 2011;63:240–S252. Available:

Nam YS, Jeong JJ, Han SH, Park SE, Lee SM, Kwon MJ, Ji JH, Kim KS. An anatomic and clinical study of the suprascapular and axillary nerve blocks for shoulder arthroscopy, J. Shoulder Elb. Surg. 2011; 20:1061–1068.


Chung F, Ritchie E, Su J. Postoperative Pain in Ambulatory Surgery, Anesth. Analg. 1997;85:808–816. Available:

Bogdanov A, Loveland R, Is there a place for interscalene block performed after induction of general anaesthesia?, Eur. J. Anaesthesiol. 2005;22:107–110. Available:

Desroches A, Klouche S, Schlur C, Bauer T, Waitzenegger T, Hardy P., Suprascapular Nerve Block Versus Interscalene Block as Analgesia After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Noninferiority Trial, Arthrosc. J. Arthrosc. Relat. Surg. 2016; 32:2203–2209. Available:

Pitombo PF, Meira Barros R, Matos MA, Pinheiro Módolo NS, Selective Suprascapular and Axillary Nerve Block Provides Adequate Analgesia and Minimal Motor Block. Comparison with Interscalene Block, Brazilian J. Anesthesiol. 2013;63: 45–58. Available:

Ajmani ML, The cutaneous branch of the human suprascapular nerve., J. Anat. 1994;185(Pt 2):439–42. Available:

Schroeder K, Andrei AC, Furlong MJ, Donnelly MJ, Seungbong H, Becker AM, Efeito perioperatório do índice de massa corporal elevado no bloqueio do nervo periférico: uma análise de 528 bloqueios interescalênicos guiados por ultrassom, Rev. Bras. Anestesiol. 2012;62:33–38. Available:

Gerber C, Blumenthal S, Curt, A Werner CML. Effect of selective experimental suprascapular nerve block on abduction and external rotation strength of the shoulder, J. Shoulder Elb. Surg. 2007;16: 815–820.


Skedros JG, Adondakis MG, Knight AN, Pilkington MB. Frequency of Shoulder Corticosteroid Injections for Pain and Stiffness After Shoulder Surgery and Their Potential to Enhance Outcomes with Physiotherapy: A Retrospective Study, Pain Ther. 2017;6: 45–60. Available: