Shoulder Anterior Capsule Block Combined With Supra Scapular Nerve Versus Interscalene Block as Sole Anesthesia in Shoulder Arthroscopy

Ultrasonographic peripheral nerve block has been a popular technique not only for pain management but also for surgical anesthesia especially in patients with comorbidities, avoiding complications associated with general anesthesia (airway-difficulties, hemodynamic instability, etc.) and ensuring excellent pain control, reducing peri-operative consumption of opioids and their side effects, and improving patient satisfaction.

Interscalene block (ISB) is the gold stander anesthetic technique for shoulder surgeries but hemi-diaphragmatic paralysis still problematic. The SHAC is the combination of two different blocks. The first block is the inter fascial space between the deep layer of the deltoid fascia and the superficial layer of the subscapularis fascia, anterior to the subscapularis myotendinous junction. This inter fascial space, we can reach both the axillary nerve and the subscapular nerves, the lateral pectoral nerve, and the musculocutaneous nerve results in achieving adequate anesthesia and analgesia without phrenic nerve affection.

The present study will be conducted to compare of SHAC block combined with suprascapular nerve block and Interscalene block as an anesthetic option in shoulder arthroscopic surgery may allow adequate postoperative analgesia and decrease the overall opioid usage and enhanced patient recovery

Inclusion criteria

• Written informed consent from patients.
• BMI less than or equal 30 kgm .
• Age 18-75 years old.
• ASA class I, II and III.

Exclusion criteria

• Allergy to local anesthetics.
• Infection at site of injection.
• Patients with coagulopathy.
• Physical and mental disease which could interfere with pain scores evaluation.
• pre-existing neuropathy of the operative limb.
• Pre-existing sever pulmonary diseases (obstructive or restrictive).
• Patients with distorted local anatomy.
• Patients with chronic pain syndrom

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