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ID=CRD42019124866

PROSPERO
International prospective register of systematic reviews

A comparison of the analgesic and respiratory effects of supraclavicular and

interscalene blocks for shoulder surgery: a systematic review and meta-
analysis
Nasir Hussain, Faraj Abdallah

Citation
Nasir Hussain, Faraj Abdallah. A comparison of the analgesic and respiratory effects of supraclavicular and
interscalene blocks for shoulder surgery: a systematic review and meta-analysis. PROSPERO 2019
CRD42019124866 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?
ID=CRD42019124866

Review question
To compare the analgesic and respiratory effects of the supraclavicular block (SCB) and the interscalene
block (ISB) in adult patients undergoing shoulder surgery.

Searches
A systematic search strategy will be created for the US National Library of Medicine database (MEDLINE);
the Cochrane Database of Systematic Reviews; and the Excerpta Medica database (EMBASE) from
inception to December 1, 2018.

The search strategy will be developed using medical subject headings (MeSH) and keywords relevant to the
central research question of this review.

The bibliographies and citations of all included articles will also be hand searched to identify any other
potentially relevant trials, and we will hand search the published abstracts of the following international
meetings: American Society of Anesthesiologists (ASA) 2011-2018, American Society of Regional
Anesthesia and Pain Medicine (ASRA) 2013-2018, the European Society of Regional Anesthesia (ESRA)
2014-2018, and the European Society of Anesthesiology (ESA) 2015-2018.

The clinical trial registry (www.ClinicalTrials.gov) will also be searched, and the authors of potentially
relevant ongoing or completed trials will be contacted for additional data.

Additional search strategy information can be found in the attached PDF document (link provided below).

Search strategy
https://www.crd.york.ac.uk/PROSPEROFILES/124866_STRATEGY_20190209.pdf

Types of study to be included

Inclusion:
-Randomized or quasi-randomized trials involving adult patients (≥18 years old) undergoing elective
shoulder surgery to receive either SCB or ISB.

Exclusion:
-Studies involving procedures in which additional sources of innervation may be involved, such as repair of
the clavicle, biceps tendon, or humerus fractures.
-Trials of volunteers not having shoulder surgery.

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Condition or domain being studied

The supraclavicular block (SCB) has been proposed and used as an interscalene block (ISB) alternative,
but evidence of the comparative analgesic and respiratory-sparing effects is conflicting.
This meta-analysis will therefore compare the analgesic and respiratory effects of SCB and ISB for shoulder
surgery.

Participants/population
Adult patients (≥18 years old) undergoing elective shoulder surgery, and receiving either SCB or ISB.

Intervention(s), exposure(s)
Supraclavicular block.

Comparator(s)/control
Interscalene block.

Main outcome(s) [1 change]

Co-primary outcomes:
i) Analgesic consumption;
ii) Postoperative respiratory function.
Measures of effect
Not applicable

Additional outcome(s) [1 change]

Secondary analgesic outcomes:
-Postoperative pain severity;
-Cumulative postoperative oral morphine equivalent consumption (mg).

Secondary safety outcomes:

-Postoperative opioid-related side effects;
-Nerve block-related complications;
-Other respiratory complications.
Measures of effect
Not applicable

Data extraction (selection and coding)

A standardized data extraction form will be created and piloted by an independent reviewer (N.H.). Relevant
data will extracted in duplicate by two independent reviewers. Any discrepancies in data extraction will be
discussed until a consensus was reached. If an agreement cannot be made, a third reviewer (F.A.) will
assess the discrepant data point and made the final decision. The data extraction will collect information
relating to the year of publication; age of study participants; year of publication; type of shoulder surgery
performed; type of block performed; block localization technique; nature and dose of local anesthetic
injected; surgical anesthetic used; analgesic regimens; nature of primary outcome studied; pain scores;
analgesic consumption at all reported follow-up times; level of satisfaction with pain relief; duration of
analgesia; respiratory and functional outcomes; opioid- and block-related adverse events; and hospital and
post-anesthesia care unit (PACU) duration of stay.

Risk of bias (quality) assessment

The methodological quality of each study will be assessed using the Cochrane Collaboration's risk of bias
tool.

Ratings of low, unclear, or high risk of bias will be assigned to each domain by two independent reviewers.
Any disagreements regarding risk of bias assessment will be discussed until a decision is reached. In
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situations when a decision cannot be reached, a third reviewer (F.A.) will assess the trial in question and
make a final decision.

Strategy for data synthesis

We will use the inverse variance method with random-effects modeling for the data analysis. If the
dichotomous data can be pooled, the Mantel-Haenszel random-effects model will be used, and for the
primary outcomes of this review, a weighted mean difference (WMD) will be calculated, along with a 95%
CI.
The primary outcomes of this review will also be assessed for heterogeneity by calculating an I² statistic.

Analysis of subgroups or subsets

Subgroup analyses may be carried out, depending on the data retrieved.

Contact details for further information

Nasir Hussain
nasir.hussain@osumc.edu

Organisational affiliation of the review

The Ohio State University, Wexner Medical Center

Review team members and their organisational affiliations [1 change]

Dr Nasir Hussain. Department of Anesthesiology, The Ohio State University, Wexner Medical Center, USA
Dr Faraj Abdallah. Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Research
Institute, Canada

Type and method of review

Intervention, Meta-analysis, Systematic review

Anticipated or actual start date

01 September 2018

Anticipated completion date

31 March 2019

Funding sources/sponsors
None

Conflicts of interest
None known

Language
English

Country
Canada, United States of America

Stage of review [1 change]

Review Completed published

Details of final report/publication(s) or preprints if available [1 change]

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Is Supraclavicular Block as Good as Interscalene Block for Acute Pain Control Following Shoulder Surgery?
A Systematic Review and Meta-analysis. Anesth Analg. 2020 Feb 24. doi:
10.1213/ANE.0000000000004692. [Epub ahead of print].
https://www.ncbi.nlm.nih.gov/PubMed/32102013

Subject index terms status

Subject indexing assigned by CRD

Subject index terms

Analgesics; Brachial Plexus Block; Humans; Orthopedic Procedures; Pain, Postoperative; Postoperative
Care; Postoperative Period; Respiration; Shoulder; Shoulder Joint; Shoulder Pain; Treatment Outcome

Date of registration in PROSPERO

06 March 2019

Date of first submission

09 February 2019

Stage of review at time of this submission [1 change]

Stage Started Completed

Preliminary searches Yes Yes

Piloting of the study selection process Yes Yes

Formal screening of search results against eligibility criteria Yes Yes

Data extraction Yes Yes

Risk of bias (quality) assessment Yes Yes

Data analysis Yes Yes

Revision note

Paper now published.

The record owner confirms that the information they have supplied for this submission is accurate and
complete and they understand that deliberate provision of inaccurate information or omission of data may
be construed as scientific misconduct.

The record owner confirms that they will update the status of the review when it is completed and will add
publication details in due course.

Versions

06 March 2019
27 October 2020

PROSPERO
This information has been provided by the named contact for this review. CRD has accepted this information in good
faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this

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submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration
record, any associated files or external websites.

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