Estudo clínico randomizado comparativo entre bloqueio de plexo braquial via interescalênico e costoclavicular quanto aos efeitos respiratórios e analgésicos em paciente submetidos à artroscopia de ombro

Abstract

Introduction: Interscalene block (ISB) is considered the gold standard for analgesia in shoulder arthroscopy, providing excellent postoperative pain control. However, it has significant limitations due to hemidiaphragmatic paralysis, resulting in respiratory compromise. Costoclavicular block (CCB), a more recent technique, offers a potentially safer alternative by allowing access to the brachial plexus cords farther away from the phrenic nerve. Objective: To compare the prevalence of diaphragmatic paralysis between costoclavicular and interscalene brachial plexus blocks in the postoperative period of shoulder arthroscopy, evaluating the analgesic effects and respiratory safety profile. Methodology: Prospective, randomized, double-blind clinical trial conducted with 92 patients (18-80 years, ASA I-III) undergoing shoulder arthroscopy. Participants were randomized into the CCB Group (n=46) and ISB Group (n=46), receiving 20 mL of 0.375% ropivacaine under ultrasound guidance. The primary outcome was hemidiaphragmatic paralysis assessed by ultrasound at 30 minutes post-blockade, 30 minutes, and 180 minutes post-anesthesia. Secondary outcomes included pain scores at 48 hours, time to first pain complaint, morphine consumption, and complications. Statistical analysis was performed using SPSS 26, considering p<0.05. Results: BCC demonstrated a significantly lower incidence of hemidiaphragmatic paralysis at all assessed time points: 30 minutes after block performance (56.5% vs. 91.3%, p<0.001), 30 minutes (47.8% vs. 91.3%, p<0.001), and 180 minutes after admission to the postanesthesia care unit (PACU) (47.8% vs. 91.3%, p<0.001). However, the BCC group showed higher initial morphine consumption (p=0.008) and higher pain scores at PACU admission (p=0.002) and at discharge from the post-anesthesia care unit (p=0.012). No differences were observed in pain scores at other time points, time to first pain complaint, or complication rates. Patient satisfaction was 100% in both groups. Conclusion: BCC demonstrated an advantage in preserving respiratory function, establishing itself as a safer alternative for patients with respiratory comorbidities. Although associated with a greater initial need for analgesic rescue, the subsequent analgesic equivalence supports BCC as an effective technique.