Abstract
OBJECTIVES: To compare the safety and efficacy of ultrasound-guided anterior suprascapular nerve block (ASSB) versus interscalene block (ISB) in elderly patients undergoing shoulder arthroscopy surgery under general anesthesia. METHODS: Elderly patients who underwent arthroscopic shoulder surgery under general anesthesia at the Central Hospital Affiliated to Shandong First Medical University from January 2022 to December 2023 were retrospectively included in this study. Demographic characteristics, intraoperative variables, perioperative vital signs, pulmonary function data, hemidiaphragmatic excursion (HDE), incidence of hemidiaphragmatic Paralysis (HDP), numerical rating scale (NRS) pain scores, and complications were compared between the two groups. RESULTS: A total of 223 patients aged 60 years or older who underwent shoulder arthroscopies between January 2022 and December 2023 were included in this retrospective study. Depending on the nerve block method, patients were divided into two groups: the ISB (n = 108) and ASSB (n = 115) groups. Patients in the ASSB group demonstrated significantly greater ipsilateral HDE during quiet breathing (1.47 ± 0.42 cm) compared to the ISB group (1.36 ± 0.23 cm) (P = 0.010) and higher forced vital capacity (2.32 ± 0.52 L/min vs. 2.12 ± 0.85 L/min, P = 0.036). The ASSB group had a higher rate of no HDP (52.17% vs. 30.56% in ISB, P = 0.004) but lower incidence of partial HDP (65.74% vs. 46.09%). Postoperative NRS scores during activity were comparable between the two groups; however, NRS scores at rest were higher in the ASSB group. Additionally, the ASSB group had a lower overall incidence of complications, especially phrenic nerve block, yet the difference did reach statistical significance. CONCLUSIONS: Ultrasound guided ASSB is a feasible anesthesia alternative for elderly patients undergoing shoulder arthroscopy surgery. Compared to ISB, it provides better preservation of diaphragm function and reduces respiratory-related complications, while maintaining effective analgesic effects.