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INTRODUCTION: arthroscopic shoulder surgery has recently gained popularity, however, postoperative pain is reported as moderate to severe. Regional anesthesia is useful for the control of postoperative pain. Interscalene and supraclavicular blocks produce diaphragmatic paralysis in different proportions. The aim of this study is to find the percentage and duration of hemidiaphragmatic paralysis, by means of ultrasonographic measurements, correlated with spirometry, comparing the supraclavicular approach with interscalene. MATERIAL AND METHODS: clinical, controlled and randomized trial. Fifty-two patients, between 18 and 90 years of age, scheduled for arthroscopic shoulder surgery were included, divided into 2 groups (interscalene or supraclavicular block). Diaphragmatic excursion was measured and spirometry was performed prior to admission to the operating room and 24 hours after installation of the block, the study concluded 24 hours after the anesthetic event. RESULTS: vital capacity was reduced by 0.7% in the supraclavicular block and 7.7% for the interscalene, FEV1 was reduced by 0.2% for the supraclavicular and 9.5% in the interscalene with a statistically significant difference (p = 0.001). Diaphragmatic paralysis in spontaneous ventilation appeared in both approaches at 30 minutes, without significant difference. At 6 and 8 hours, paralysis continued in the interscalene group, while in the supraclavicular approach it remained preserved compared to the baseline. CONCLUSIONS: supraclavicular block is as effective as interscalene block in arthroscopic shoulder surgery, with less diaphragmatic block (1.5 times more diaphragmatic paralysis in interscalene).

INTRODUCCIÓN: la cirugía artroscópica de hombro ha ganado popularidad recientemente; sin embargo, el dolor postquirúrgico se reporta de moderado a severo. La anestesia regional es útil para el control del dolor postquirúrgico. El bloqueo interescalénico y supraclavicular produce parálisis diafragmática en diferente proporción. Se busca encontrar cuál es el porcentaje y duración de la parálisis hemidiafragmática mediante mediciones ultrasonográficas, correlacionadas con espirometría comparando el abordaje supraclavicular con interescalénico. MATERIAL Y MÉTODOS: ensayo clínico, controlado y aleatorizado. Se incluyeron 52 pacientes entre 18 y 90 años, programados para cirugía artroscópica de hombro, divididos en dos grupos (bloqueo interescalénico y supraclavicular). Se midió la excursión diafragmática y se realizó una espirometría previo al ingreso al quirófano y a las 24 horas de instalación del bloqueo, el estudio concluyó a las 24 horas del evento anestésico. RESULTADOS: la capacidad vital se redujo en 0.7% en el grupo del bloqueo supraclavicular y 7.7% en el grupo interescalénico, el VEF1 se redujo en 0.2% en el supraclavicular y 9.5% en el interescalénico con una diferencia estadísticamente significativa (p = 0.001). La parálisis diafragmática en ventilación espontánea se presentó en ambos abordajes a los 30 minutos, sin diferencia significativa. A las seis y ocho horas continuó la parálisis en el grupo interescalénico, mientras que en el abordaje supraclavicular se mantuvo en comparación con la basal. CONCLUSIONES: el bloqueo supraclavicular resulta tan efectivo como el bloqueo interescalénico en la cirugía artroscópica de hombro, con menor bloqueo diafragmático (1.5 veces más parálisis diafragmática en el interescalénico).

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Patients undergoing joint replacement surgery may experience intense and sustained postoperative pain due to inappropriate analgesia that delays recovery and hospital discharge. Traditionally, postoperative analgesia following arthroplasty is achieved with scheduled analgesia, either patient-controlled or with epidural spinal blocks. The former techniques have advantages and disadvantages. Recently, peripheral nerve block has emerged as an appropriate alternative for postoperative pain. Numerous trials report that the use of multimodal analgesia based on peripheral nerve blocks may control pain and offer functional results similar to those obtained with continuous epidural blocks or systemic opioids, but without their unwanted systemic effects. This review discusses the indications, benefits and adverse effects associated with standard and new analgesic techniques.

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INTRODUCTION: General anesthesia is considered as the technique of choice for shoulder surgery, either alone or combined. We propose to show the feasibility of using guided interscalene block as the single anesthetic technique for total shoulder arthroplasty. MATERIAL AND METHODS: Neurostimulation-guided interscalene block plus sedation with dexmedetomidine were used. The following were measured intraoperatively: latency time, intraoperative analgesia, motor block according to Monzo's scale, success rate, adverse events and complications. The following were measured postoperatively: duration of postoperative analgesia and pain intensity with a visual analogue scale at 6, 12 and 24 hours. Patient satisfaction was also measured. RESULTS: Intraoperative analgesia was appropriate in 100% of patients. Motor block was grade 0 in 76.4% and grade 1 in 23.6%, which is appropriate for surgery. The success rate was 100%. Mean postoperative pain at 6 hours was 0.13 +/- 0.54 points in the visual analogue scale; 1.67 +/- 1.15 at 12 hours, and 3.15 +/- 1.66 points at 24 hours. 54.5% of patients were very satisfied and 45.5% were satisfied. Complications occurred in 8.18%. CONCLUSION: This type of surgery is feasible with interscalene block plus sedation; it is a safe and efficacious technique.

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