BMC Surg. 2026 Aug 4;26(1):732. doi: 10.1186/s12893-026-04109-2.
ABSTRACT
BACKGROUND: Shoulder arthroscopy causes substantial postoperative pain and operating room resource use. Randomized trials integrating postoperative pain trajectory with sensitivity-tested cost analysis are limited. We compared combined three-block regional anesthesia with standard general anesthesia in elective shoulder arthroscopy.
METHODS: In this prospective, randomized, parallel-group, single-center trial, 50 adults undergoing elective shoulder arthroscopy in the beach-chair position were allocated 1:1 to ultrasound-guided combined interscalene, supraclavicular, and superficial cervical plexus blocks with dexmedetomidine sedation or standard general anesthesia. The primary outcome was the resting Numeric Rating Scale (NRS, 0-10) pain score at 4 h. Pre-specified secondary outcomes included pain scores at the remaining timepoints, movement-evoked pain, patient and surgeon satisfaction, surgical duration, and intraoperative opioid consumption. Exploratory post-hoc outcomes included cumulative pain burden (area under the NRS-time curve), total perioperative cost, hemodynamic parameters, perioperative time components, rescue analgesia, postoperative nausea and vomiting, and complications.
RESULTS: Resting NRS at 4 h was lower with regional anesthesia than with general anesthesia (median 0 [IQR 0-0] vs. 4 [IQR 3-5]; Hodges-Lehmann median difference 4 points, 95% CI 3 to 4; p < 0.001) and remained lower through the 4-hour timepoint. Movement NRS increased at 12 and 24 h after block regression. Among the pre-specified secondary outcomes, patient and surgeon satisfaction was higher with regional anesthesia, while surgical duration was similar. In exploratory post-hoc analyses, the 24-hour cumulative pain burden was lower with regional anesthesia, total perioperative cost was approximately 38% lower with regional anesthesia across all sensitivity scenarios, total operating room time was shorter, and complication types differed qualitatively between groups with no significant difference in incidence detected.
CONCLUSIONS: Combined regional anesthesia provided superior early analgesia and greater patient and surgeon satisfaction than general anesthesia. Exploratory post-hoc analyses suggested lower 24-hour cumulative pain burden, lower total perioperative cost and shorter operating room utilization. These economic and operational findings should be considered hypothesis-generating.
TRIAL REGISTRATION: Clinicaltrials Registration No: NCT06674954, Date: October 16, 2024.
PMID:42958194 | DOI:10.1186/s12893-026-04109-2
