Paracoracoid Subscapularis Plane Block Versus Infraclavicular and Subomohyoid Blocks for Pain Relief in Unilateral Shoulder Surgeries: A Randomized, Double-Blind Comparative Study

Background: The techniques of paracoracoid subscapularis plane, infraclavicular, and subomohyoid blocks are innovative methods used in shoulder procedures to prevent phrenic nerve block and hemi-diaphragmatic paresis, as opposed to using the interscalene block.
Objective: The objective of this study was to evaluate the analgesic efficacy and outcomes of two different blocks in unilateral shoulder surgery.
Patients and Methods: Eighty patients were randomly distributed into two equal study groups: group P was subjected to paracoracoid subscapularis plane block and group ISO to infraclavicular and subomohyoid block. After the conduction of general anesthesia, the two blocks were done by injecting 15 ml of bupivacaine 0.5% under an ultrasound image.
Results: No statistically significant difference was detected in the visual analog scale among the study groups immediately after the operation and up to 8 hours. However, after 12 hours, there was a clear and substantial difference, with the ISO group showing an excellent analgesic effect. The intra-operative heart rate exhibited more stability in group P; this difference. The heart rate exhibited increased stability after 1.5 hours in the ISO group; however, this change was not statistically significant. The intra-operative mean arterial blood pressure didn’t exhibit any statistically significant difference among the two groups, except after 1 hour, where the ISO group demonstrated a more pronounced and stable effect. There was a significant statistical difference in opioid intake among the ISO group and the control group.
Conclusion: Paracoracoid subscapularis nerve block is more efficacious in shoulder procedures as it does not damage the phrenic nerve, unlike the subomohyoid block.