Anterior Suprascapular and Axillary vs. Interscalene Block for Analgesia and Diaphragmatic Function in Shoulder Surgery

Shoulder surgeries are among the most frequently performed orthopedic interventions and are often associated with moderate to severe postoperative pain. In these procedures, effective pain management is crucial for early rehabilitation and patient comfort. Peripheral nerve blockade is widely used for postoperative analgesia in shoulder surgery. While the interscalene brachial plexus block is considered the gold standard for pain control, it is frequently associated with unintended phrenic nerve blockade, leading to hemidiaphragmatic paresis. To minimize respiratory complications while maintaining effective analgesia, alternative diaphragm-sparing regional anesthesia techniques, such as the combination of suprascapular and axillary nerve blocks, have been introduced. The aim of this study is to compare the analgesic efficacy and respiratory functions preservation of the ultrasound-guided anterior approach suprascapular combined with axillary nerve block versus interscalene block in patients undergoing shoulder surgery

Inclusion Criteria: * Patients aged between 18 and 65 years * American Society of Anesthesiologists (ASA) physical status I, II, or III * Patients scheduled to undergo elective arthroscopic shoulder surgery * BMI between 18 and 30 kg/m2 * Ability to provide written informed consent Exclusion Criteria: * Known allergy or hypersensitivity to local anesthetics * Presence of localized infection at the planned injection site * Severe coagulopathy or active use of anticoagulant medications * Contralateral phrenic nerve palsy or a diagnosis of severe chronic obstructive pulmonary disease (COPD) * History of chronic opioid consumption or neuropathic pain