Anterior vs Posterior Approaches to Suprascapular Nerve Block in Arthroscopic Shoulder Surgery

Anterior vs Posterior Approaches to Suprascapular Nerve Block in Arthroscopic Shoulder Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Anterior vs Posterior Approaches to Suprascapular Nerve Block in Arthroscopic Shoulder Surgery Ebru Girgin Dinc, Mesure Gul Nihan OZDEN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8865958/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 12 You are reading this latest preprint version Abstract Background Suprascapular nerve block (SSNB) can provide effective postoperative shoulder analgesia with less risk of phrenic nerve involvement than the interscalene brachial plexus block. We compared the analgesic efficacy and diaphragmatic effects of anterior and posterior SSNB using 5 mL of local anaesthetic in arthroscopic shoulder surgery. Methods This was a prospective, randomised, single-blind, two-parallel-group study of ASA I-III participants aged 18–80 years undergoing elective arthroscopic shoulder surgery recruited between July 2022 to June 2023. Participants underwent ultrasound-guided SSNB anterior and posterior approaches with 5 mL volume of 0.5% concentration bupivacaine. Randomisation was conducted 1:1 using a computer programme, and allocation was implemented using the sealed-envelope method. Participants and outcome assessors were blinded to group assignment. The primary outcome was the postoperative shoulder pain score measured on the Visual Analogue Scale (VAS) at 30 min, 4 h, 6 h, 12 h, and 24 h postoperatively. Secondary outcomes included opioid consumption, diaphragmatic thickening fraction, nausea, vomiting, and patient satisfaction. Results Sixty participants were randomised and analysed (30 per group). Postoperative pain (primary outcome) measured by VAS was lower in the anterior approach (GA) than the posterior approach (GP) at 30 min, 4 h, 6 h, and 12 h (p = 0.001, p = 0.001, p = 0.008, p = 0.001). Pain at 24 h was not statistically different after Bonferroni correction (α-adj = 0.01; p = 0.020). GA had lower cumulative opioid consumption at 30 min and 4 h (both p = 0.001). Opioid use was similar at 24 h (p = 0.140). Patient satisfaction was higher in GA (p = 0.001). PONV was lower in GA (p = 0.001). DTF did not differ between groups (p = 0.253). No serious adverse events related to the block occurred. One participant developed an urticarial rash from opioid administration, and one participant reported chest pain requiring further evaluation. Conclusions In arthroscopic shoulder surgery, the anterior approach may be a useful option for suprascapular nerve block, offering better early analgesia without an apparent effect on diaphragmatic function. Ethics approval and consent to participate: Ministry of Health Istanbul Medeniyet University Goztepe Training and Research Hospital Clinical Research Ethics Committee (Istanbul Medeniyet University, Istanbul, Turkey) (No: 2022/0155; Date: 16 March 2022) Levels of Evidence: LEVEL II, Prospective Comparative Study Trial registration: ClinicalTrials.gov, NCT05442814. Prospectively registered on 18 April 2022 (first posted on 1 July 2022; first participant enrolled on 11 July 2022). Diaphragm Nerve Block Phrenic Nerve Shoulder Pain Ultrasonography Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Postoperative shoulder pain is widely recognized as intense[ 1 ]. The interscalene brachial plexus block, commonly considered the gold standard for shoulder analgesia, frequently causes hemidiaphragmatic paralysis due to phrenic nerve involvement and regional spread of local anaesthetic [ 2 – 4 ]. Hemidiaphragmatic paralysis is also linked to a shared fibrous sheath between the brachial and cervical plexuses, which enables spread to the cervical fascia, even with low anaesthetic volumes[ 5 – 7 ]. As reported by Siegenthaler et al. [ 8 ] and Laumonerie et al. [ 9 ], the anterior suprascapular nerve block may serve as an alternative to avoid hemidiaphragmatic paralysis. This study hypothesized that the anterior and posterior approaches provide different levels of analgesia and that the risk of diaphragmatic paralysis relates to block volume. The two approaches were compared by evaluating diaphragmatic contractility. MATERIALS AND METHODS Study Design This prospective, randomised, single-blind, two-parallel-group study was carried out in line with the Declaration of Helsinki (2013) and Good Clinical Practice, and was reported according to the CONSORT guidelines. Ethical approval was obtained from the Ministry of Health Istanbul Medeniyet University Goztepe Training and Research Hospital Clinical Research Ethics Committee (Istanbul Medeniyet University, Istanbul, Turkey) (No. 2022/0155; Date: 16 March 2022). The trial was prospectively registered at ClinicalTrials.gov (NCT05442814; registered on 18 April 2022; first posted on 1 July 2022). The first participant was enrolled on 11 July 2022. Written informed consent was obtained from all participants before enrolment. Participants were recruited between July 2022 and June 2023. The present study included participants who had undergone arthroscopic rotator cuff repair and Bankart repair. The inclusion criteria encompassed participants aged 18–80 years, categorised according to the American Society of Anaesthesiologists’ (ASA) physical status I–III, and who provided both written and verbal consent. The primary exclusion criteria included coagulopathy, history of local anaesthetic drug allergy or toxicity, infection at the injection site, mental disorders, known or suggestive diaphragmatic paralysis, advanced organ failure, and pregnancy. Secondary exclusion criteria included conversion to open surgery, any adverse reaction during the study period, and missing opioid consumption data. Participants were randomised 1:1 to the anterior group (GA) or the posterior group (GP) using a computer-generated random sequence (Sealed Envelope; www.sealedenvelope.com ). Allocation was concealed with sequentially numbered, opaque, sealed envelopes prepared in advance. The envelopes were held and retrieved by a member of staff who was not involved in performing the blocks. For each participant, the next envelope in sequence was opened immediately before the peripheral nerve block, after enrolment. Blinding procedures were implemented for all research participants, personnel involved in the outcome assessment, anaesthesia, surgery, nursing, and outcome assessor. Diaphragm ultrasonography was obtained by an experienced assessor blinded to the block technique. This manuscript adheres to the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Outcome Measures The primary outcome was the postoperative shoulder pain score measured on the Visual Analogue Scale (VAS) at 30 min, 4 h, 6 h, 12 h, and 24 h postoperatively. Secondary outcomes included opioid consumption, diaphragmatic thickening fraction, nausea, vomiting, and patient satisfaction. Peripheral Block Procedure Patient demographics, including age, sex, weight, body mass index (BMI), ASA physical status, and surgery side, were recorded after randomisation. Standard monitoring (electrocardiogram, SpO2, and non-invasive arterial blood pressure) was conducted during the peripheral block procedure. The suprascapular nerve block was performed in all patients in the designated peripheral nerve block area, 30 minutes before induction of general anaesthesia. Midazolam was administered intravenously at a dose of 1 mg to alleviate symptoms of anxiety. Prior to the block procedure, aseptic surgical techniques were employed. All peripheral nerve blocks were performed by a single experienced regional anaesthetist. Diaphragmatic ultrasound assessments were performed by an experienced operator blinded to the block technique. Block success was assessed 30 minutes following administration, before anaesthetic induction. Supraspinatus and infraspinatus strength were assessed on the blocked side. Supraspinatus function was tested using the open-can and empty-can manoeuvres, while infraspinatus function was evaluated with resisted external rotation with the shoulder in neutral and the external rotation lag sign. Strength was recorded on the 0–5 Manual Muscle Testing (MMT) scale , where 0 is no muscle activation and 5 is normal strength . The suprascapular nerve block was deemed successful if any test showed a ≥ 1-grade reduction in MMT and/or a positive external rotation lag sign. Anterior Approach for Suprascapular Nerve Block In the GA, participants were positioned with the head of the bed elevated at a 45-degree angle, opposite to the targeted area, and a shoulder support was placed beneath it. This was achieved by positioning the shoulder in adduction and the elbow in flexion on the side. Ultrasound (Samsung Ultrasound H60, Samsung, Seoul, Republic of Korea) clarity was optimised by focusing 0.5 cm below the omohyoid muscle using a linear probe with a 12.5–16 MHz frequency. Following imaging of the brachial plexus, the search was directed laterally along the omohyoid muscle with a slight dorsal orientation at its lateral end. A 50-mm, 22-G insulated peripheral nerve block needle (Stimuplex® A; B. Braun, Melsungen, Germany) was inserted in plane under the omohyoid muscle, with the needle directed from posterolateral towards anteromedial (See Figure Ia). The hypoechoic suprascapular nerve, located approximately 1 cm below the skin, was reached by passing through the subfascia of a 2–3-mm-thick omohyoid muscle. When the nerve stimulator (Plexygon Nerve Stimulator, Vygon GmbH, Aachen, Germany) induced external rotation in the infraspinatus muscle and abduction in the supraspinatus muscle within the range of 0.3–0.5 mA using 0.1 ms, 2 Hz. Bupivacaine, at a concentration of 0.5% and a volume of 5 ml, was injected around the nerve. At the end of the procedure, the effects of the local anaesthetic were verified around the nerve. Posterior Approach for Suprascapular Nerve Block In the GP, participants assumed a seated position, holding the opposite shoulder with the hand on the treated side while adducting the shoulder and flexing the elbow. With the participants in the sitting position, the operator stood behind the participant, and the ultrasound machine was positioned in front of the participant on the side of the block. Ultrasound guidance was provided using the same ultrasound system and a 10–12.5 MHz linear probe on the side of the block. The upper medial part of the scapula was used to visualise the pleura in the suprascapular notch, just below the trapezius and supraspinatus muscles, from superficial to deep. The hyperechoic suprascapular nerve was identified under the transverse suprascapular ligament, approximately 4 cm from the skin. An 80-mm, 22-G insulated peripheral nerve block needle (Stimuplex® A; B. Braun, Melsungen, Germany) was inserted in plane from lateral to medial towards the target nerve (See Figure Ib). Once an appropriate motor response in the supraspinatus and infraspinatus muscles was obtained at 0.3–0.5 mA (pulse width 0.1 ms; 2 Hz) using a nerve stimulator (Plexygon Nerve Stimulator, Vygon GmbH, Aachen, Germany), we injected 5 mL of 0.5% bupivacaine perineurally. At the end of the procedure, the spread of the local anaesthetic under the transverse suprascapular ligament was confirmed. Evaluation of Diaphragm Thickening Function Diaphragmatic thickening fraction was measured in all participants using ultrasonography (Samsung Ultrasound H60, Samsung, Seoul, Republic of Korea) with a 10–16 MHz linear probe at the zone of apposition along the anterior axillary line. After imaging the diaphragm, ribs, and chest wall in B-mode, M-mode images of diaphragm movements during calm and deep breathing were created. End-inspiratory (DI) and end-expiratory (DE) diaphragm thickness measurements were recorded (See Figure II). The preoperative baseline measurement was obtained before block administration by an experienced assessor blinded to the block technique, and the postoperative measurement was repeated by the same assessor at the same point at 30 minutes in the post-anaesthesia care unit (PACU). The diaphragm thickness fraction (DTF) was calculated using the formula DTF = ([DI − DE]/ DE​) × 100. Intraoperative Management For general anaesthesia induction, fentanyl citrate (1 mcg/kg i.v.) and propofol (2 mg/kg i.v.) were administered. Rocuronium bromide (0.6 mg/kg i.v.) was used for neuromuscular blockade. Anaesthesia was maintained with sevoflurane at a minimum alveolar concentration at 1 and bispectral index (BIS) values (Medtronic, Dublin, Ireland) of 40–50. When the BIS value was 40–50, if there was a 20% increase in the arterial heart rate and/or systolic blood pressure compared to the initial value, pain was considered present. Perioperative administration of remifentanil was initiated at an infusion dose of 0.05 µg/kg/min, and the amount was titrated according to BIS and haemodynamic monitoring. Remifentanil consumption during surgery was documented. Surgical Procedures Three standard arthroscopic portals were used in all participants: a posterior viewing portal (approximately 2 cm inferior and 1 cm medial to the posterolateral acromial corner), an anterior working portal through the rotator interval slightly lateral to the coracoid process, and a lateral portal at the mid-acromial line for subacromial work. For rotator cuff repair, the lateral portal served as the main working portal for bursectomy and cuff repair, with anterolateral and/or posterolateral accessory portals added when required for suture passage and anchor placement. Subacromial decompression, with or without subacromial bursectomy, was performed when indicated. For Bankart repair, an anterosuperior and/or anteroinferior accessory portal was added as needed to mobilise the capsulolabral complex and facilitate suture-anchor placement along the anteroinferior glenoid. All procedures were performed by the same experienced orthopaedic surgeon. Postoperative Pain Management All participants were given paracetamol (15 mg/kg) intraoperatively and postoperatively. Postoperative pain control was maintained with morphine (0.5 mg/ml) in a 2-ml bolus with a 10-minute lock time using an intravenous patient-controlled analgesia (PCA) device (BodyGuard® 575Color Vision, Caesarea Medical Electronics GmbH). For patients with a VAS score of 4 or above for shoulder pain, rescue analgesia was provided with a 20-mg intravenous dose of tenoxicam. Additionally, ice was applied to the shoulders of all participants for 24 hours. In all participants, VAS scores for shoulder pain were evaluated at 30th minutes postoperatively and 4th, 6th, 12th, and 24th hours postoperatively, and the amount of opioid consumption was recorded. Postoperative nausea and vomiting were assessed using the postoperative nausea and vomiting (PONV) scale (0: none ; 1: mild nausea ; 2: nausea ; 3: vomiting once ; 4: vomiting more than once ). Ondansetron was administered intravenously at a 0.1 mg/kg dose if the score was 1 or higher. Patient satisfaction was evaluated using a 5-point Likert scale at 24 hours postoperatively (1 = not at all satisfied , 2 = not really satisfied , 3 = undecided , 4 = somewhat satisfied , 5 = very much satisfied ). Statistical Evaluation Sample size was calculated a priori for a superiority comparison, informed by internal estimates of variability (n = 20; 10 participants per group). The primary endpoint was postoperative pain burden over 24 hours, expressed as the area under the VAS–time curve (VAS AUC) from 0.5 to 24 hours, constructed from VAS scores recorded at 30 minutes, 4 hours, 6 hours, 12 hours, and 24 hours and computed using the trapezoidal rule. We prespecified a conservative minimal clinically important difference equivalent to a 0.8-point separation on the 0–10 VAS maintained across the observation window, corresponding to an AUC difference of 18.8 VASxhours. Assuming a two-sided α of 0.05, 23 participants per group were required to achieve 90% power and 28 per group to achieve 95% power; with a 10% allowance for attrition, the planned enrolment was 26 per group (total n = 52) for 90% power and 32 per group (total n = 64) for 95% power. The Number Cruncher Statistical System software (version 2007; Kaysville, UT, USA) was used for statistical analysis. When evaluating the study data, descriptive statistical methods (mean, standard deviation, median, frequency, ratio, minimum, maximum, and confidence intervals) were used, along with the Shapiro–Wilk test to assess the data distribution. For quantitative data, between-group comparisons were performed using an independent-samples t-test for normally distributed variables and the Mann–Whitney U test for non-normally distributed variables. Spearman's correlation coefficient was used to determine the relationship between quantitative data. Repeated measures were analysed using a two-way mixed (repeated-measures) ANOVA to examine group, time, and group×time effects; when the data were not suitable for a parametric analysis, non-parametric tests were used. Changes over time within each group were assessed using the Friedman test. If the Friedman test was significant, post hoc pairwise comparisons were performed using the Wilcoxon signed-rank test, with 30 minutes postoperatively as the reference time point. Significance was evaluated at p < 0.001 and p < 0.05 levels. Bonferroni correction was applied to account for multiple comparisons. For five between-group time-point comparisons, the Bonferroni-adjusted significance threshold was set at 0.01 (0.05/5). For post-hoc pairwise comparisons against the 30-minute postoperative reference (k = 4), the Bonferroni-adjusted threshold was set at 0.0125 (0.05/4). Graphical analyses of VAS scores, opioid consumption, and diaphragmatic thickness were performed using R (version 4.1.2; R Core Team, 2021) with the Rplot05 and ggplot2 packages. RESULTS Sixty-four participants who met the inclusion criteria were enrolled and randomized into two groups. Four participants were excluded from the final analysis in accordance with the secondary exclusion criteria. Two were excluded because of protocol deviations: one due to a postoperative malfunction of the patient-controlled analgesia (PCA) device, and one because the procedure required conversion to open surgery for a latissimus dorsi muscle flap. Of the remaining two, one developed an urticarial rash attributed to opioid administration, and the other reported chest pain requiring further clinical evaluation. As a result, 60 participants were included in the final analysis (See Consort Diagram). Baseline demographic characteristics were similar between the groups; however, Bankart repair was performed only in the GA group (See Table I). Hemodynamic data and BIS values were also similar between the groups (p > 0.05). The primary outcome, postoperative shoulder pain assessed by VAS, was significantly lower in GA than in GP at 30 min, 4 h, 6 h, and 12 h, but not at 24 h after Bonferroni correction. VAS scores for postoperative shoulder pain were statistically significantly lower in GA than in GP at 30 min, 4 h, 6h, 12h, postoperatively (p = 0.001, p = 0.001, p = 0.008, p = 0.001, respectively; see Figure III). VAS scores for postoperative shoulder pain at 24 h postoperatively were lower in GA than in GP, but this difference did not remain statistically significant after Bonferroni correction for the five between-group time-point comparisons (α-adj = 0.01; p = 0.020). Within-group changes over time were statistically significant in both groups, based on the Friedman test, GA p = 0.001 and GP p = 0.001. For post-hoc pairwise time comparisons, with 30 min postoperatively as the reference time point, Wilcoxon signed-rank tests with Bonferroni correction were applied; under this correction, the only statistically significant within-group comparison was found in GP between 30 min and 24 h postoperatively ([Wilcoxon–Bonferroni p = 0.001; k = 4, α-adj = 0.0125]; see Table II). Perioperative opioid consumption was lower in the GA group than in the GP group (0.44 (1.06) mg vs 1.90 (3.54) mg; p = 0.040). Cumulative opioid consumption was statistically significantly lower in GA than in GP at 30 min postoperatively and 4 h postoperatively (both p = 0.001). At 6 h postoperatively and 12 h postoperatively, the between-group differences were smaller (p = 0.024 and p = 0.033, respectively). At 24 h postoperatively, cumulative opioid consumption was similar between groups (p = 0.140; [Bonferroni correction for five time-point comparisons, α-adj = 0.01]; see Table III and Figure III). Rescue analgesia use was also significantly lower in the GA than in the GP. Nevertheless, the distribution of rescue analgesia usage over time was similar between groups (See Table IV). The number of patients with a PONV score of 1 or more was significantly lower in the GA than in the GP ((n) 4 vs 12; p = 0.001). Patient satisfaction scores was significantly lower in the GA than the GP [5 point Likert Patient Satisfaction Scale; 3 point= (GA(n) = 0; GP(n) = 11); 4 point= (GA(n) = 1; GP(n) = 13); 5 point= (GA(n) = 29; GP(n) = 6); (p = 0.001)]. DI decreased from preoperative to postoperative measurements in both groups with a significant main effect of time (F = 4.942, p = 0.030), and no time-by-group interaction (F 0.999, see Figure IV). DE showed no significant change over time effect (F = 0.397, p = 0.531), and no interaction with group (F = 0.040, p = 0.646, see Figure IV). DTF decreased postoperatively in both groups with a significant main effect of time (F = 11.497, p = 0.001), and no time-by-group interaction (F = 2.195, p = 0.144, see Figure IV). The postoperative change in diaphragmatic thickening fraction DTF (ΔDTF) did not differ between groups (p = 0.253, See Figure IV). There were no statistically significant correlations between groups for age, BMI, or preoperative Di, De and DTF values (p > 0.05). Similarly, there were no statistically significant differences in the ΔDTF values according to surgery side, asthma status, or sex (p > 0.05). A weak correlation was observed between the ΔDTF and postoperative pain scores at the 30th minute (R² = 0.047, p = 0.097), indicating no statistically significant association with early postoperative pain intensity. DISCUSSION In this study, a single-shot anterior suprascapular nerve block with 5 mL of local anaesthetic was associated with lower pain scores in the early postoperative period, reduced opioid requirements, less nausea and vomiting, and higher patient satisfaction. However, at 24 hours, VAS scores for postoperative shoulder pain and cumulative opioid consumption were similar between groups, suggesting that a single-injection block with this volume does not provide long-lasting analgesia. Small between-group differences at 6 and 12 hours postoperatively, which did not remain statistically significant after correction, point to a modest early opioid-sparing effect rather than a sustained benefit. We also found no between-group difference in diaphragmatic contractility. The suprascapular nerve typically arises from the upper brachial plexus (C5–C6) [ 10 ]. It supplies motor innervation to the supraspinatus and infraspinatus muscles and contributes to articular afferents from the shoulder joints [ 11 ]. Cadaver mapping data show consistent suprascapular nerve innervation of the posterosuperior quadrant of the glenohumeral capsule, whilst branches of the axillary nerve innervate the posteroinferior and anteroinferior quadrants, and the superior nerve to the subscapularis more commonly innervates the anterosuperior quadrant [ 12 ]. Reports also describe innervation of the acromioclavicular joint through combined contributions from articular branches of the lateral pectoral nerve and the acromial branch of the suprascapular nerve [ 2 , 12 ]. This anatomical basis supports the analgesic efficacy of the suprascapular nerve block in shoulder surgery. Although clinicians generally consider the suprascapular nerve’s cutaneous territory limited, reports on cutaneous contribution vary and remain inconsistent; in some individuals, sensory spread to the deltoid region may occur via a proximally arising cutaneous branch [ 13 , 14 ]. In the supraclavicular fossa, the suprascapular nerve lies beneath the omohyoid muscle, which measures approximately 2–3 mm in thickness. At this level, the nerve measures approximately 2–3 mm in diameter and extends for about 10 mm. In this region, the distance between the suprascapular nerve and the brachial plexus ranges from 4 to 15 mm, with a mean of 9 mm [ 15 ]. This proximal course of the suprascapular nerve is clinically important during regional nerve block techniques. For shoulder analgesia, clinicians traditionally use the interscalene brachial plexus block (ISB), but it carries a high risk of haemidiaphragmatic paralysis [ 16 – 18 ]. Meta-analyses show that, compared with standard ISB, several strategies that aim to reduce phrenic nerve involvement [superior trunk block (STB), extrafascial or low-concentration ISB, supraclavicular block, and combined infraclavicular–suprascapular techniques] reduce this risk; however, some ISB comparisons suggest that dose reduction may slightly worsen pain outcomes [ 18 ]. Although clinicians can perform ultrasound-guided ISB with low doses, published data indicate that even low volumes do not reliably spare the diaphragm and that clinically relevant rates of phrenic nerve paralysis may persist [ 19 , 20 ]. As a respiratory safer alternative to ISB, clinicians use superior trunk block (STB), an ultrasound-guided technique targeting the C5–C6-derived superior trunk proximal to the branching point of the suprascapular nerve [ 21 – 23 ]. Studies report that STB provides analgesia/anaesthesia comparable to ISB whilst markedly reducing haemidiaphragmatic paralysis and stellate ganglion-related adverse effects, without dyspnea [ 22 ]. Investigators have also described a more easily applied “sandwich-injection” modification that can provide effective bilateral shoulder anaesthesia/analgesia with minimal change in diaphragmatic excursion [ 24 ]. Dose-optimisation data suggest that haemidiaphragmatic dysfunction decreases as the administered dose decreases; however, these data also suggest shorter analgesia duration and a small increase in pain and opioid requirement later in the postoperative period [ 21 ]. Randomised studies and MEV90 calculations support this balance [ 25 , 26 ]. Within this framework, suprascapular nerve block—using different approaches—has emerged as an option to reduce the risk of haemidiaphragmatic paralysis in arthroscopic rotator cuff surgery [ 27 ]. Using 15 mL, studies show that the anterior approach produces sensory and motor block levels like ISB, exerts a greater trunk-level effect than the posterior approach, and causes less respiratory involvement than ISB with either approach [ 28 ]. Another study using a similar volume also reported a superior trunk effect with the anterior approach [ 29 ]. Although clinicians can easily perform the anterior approach, it targets the nerve at a more proximal level after it separates from the trunk, raising questions about diaphragm-sparing volumes [ 8 , 9 ]. Cadaver (MEV90 4.2 mL) and clinical effective-dose studies (ED50 2.646 mL and ED95 3.043 mL) report diaphragm-sparing dose ranges for the anterior approach; authors suggest that low volumes (4.2–6 mL) may reduce diaphragmatic involvement and may lower rates of haemidiaphragmatic paralysis and dyspnoea compared with ISB [ 20 , 30 – 33 ]. However, the literature has not yet reported a direct clinical comparison between a low-volume anterior approach and the conventional posterior technique. We believe this study contributes to the literature by comparing anterior and posterior approaches using a 5 mL local anaesthetic volume. The proximity of the anterior suprascapular approach to the trunk may shift the effect of injected local anaesthetic from an isolated SSNB towards a partial brachial plexus/superior trunk effect. In the supraclavicular fossa, the suprascapular nerve (SSN) courses close to the brachial plexus, and cadaver work shows that injection at the anterior SSN injection site can produce a staining pattern that extends to the posterior and anterior divisions and to the middle trunk. Cadaver and experimental studies also support the possibility of spread via a dorsal route to a more proximal level towards the phrenic nerve [ 11 ]. Studies show that a truly selective proximal SSNB may be achievable only with very low volumes (1–2 mL) and careful targeting; investigators confirmed target confirmation by visualising SSN separation under ultrasound and by nerve stimulation. These studies also emphasise that higher volumes can reduce selectivity [ 34 ]. Against this background, the anterior approach with 5 mL of local anaesthetic was associated with better early postoperative analgesia, lower opioid use, fewer rescue analgesics, and less need for rescue analgesia, which may reflect a clinical effect similar to a low-volume superior trunk block. In this study, the anterior group included all cases that underwent Bankart repair. If the anterior approach acted purely as a selective suprascapular nerve block, the quadrant-based innervation of the joint capsule would be expected to lead to higher early pain scores and higher analgesic requirements. However, in the early postoperative period, the anterior group had better analgesia and lower opioid use. This could be related to some proximal spread of local anaesthetic from the anterior injection site towards the superior trunk and its branches, which may have increased articular coverage. However, postoperative 24-hour opioid consumption was similar between groups, and only small differences were observed at 6 and 12 hours, suggesting that a single-injection block with this volume did not provide sustained analgesia. Instead, the early advantage likely reflects initial block spread and perioperative multimodal analgesia dynamics. Low-volume single-injection blocks may provide only limited-duration analgesia, potentially increasing the need for additional analgesia later. By contrast, adding adjuvants such as dexamethasone to the local anaesthetic may prolong block duration whilst preserving the low-volume strategy and may reduce later analgesic requirements [ 35 ]. In brachial plexus blocks, the timing of diaphragmatic assessment matters. Some data suggest that postoperative reassessment detects haemidiaphragmatic dysfunction more frequently than early post-block assessment, potentially due to cephalad spread of local anaesthetic over time [ 36 ]. Therefore, a single early measurement may underestimate diaphragmatic involvement. The Delphi consensus supports diaphragmatic excursion as a practical marker of dysfunction; however, it does not recommend a single cut-off for DTF and notes that thresholds may vary across populations [ 37 ]. In addition, a randomised STB–ISB comparison defined haemidiaphragmatic paralysis as “complete” or “partial” using explicit ultrasonography criteria that combined excursion and DTF measurements [ 38 ]. In our study, we measured postoperative DTF at 30 minutes in the PACU. During this early period, residual anaesthetic effects, respiratory pattern variability, pain, and splinting can alter inspiratory effort and influence DTF. As a result, postoperative DTF variability may reflect early postoperative variability rather than true phrenic nerve paralysis. For this reason, we focused on analyses that accounted for baseline individual differences and reported both the overall pre–post change within the cohort and the between-group comparison of change (group×time interaction), rather than relying on a single postoperative value. In line with the Delphi consensus statement that respiratory pattern and effort can influence diaphragm ultrasound indices, we also evaluated whether pain explained changes in DTF. The weak association between pain and DTF change suggests that pain alone does not drive the change; instead, it may represent one component within a multifactorial early postoperative influence. Previous reports link deltoid fascia disruption during arthroscopy to lateral and posterior portals and identify it as a potential contributor to postoperative pain [ 39 ]. In this context, the 24-hour full-shoulder ice pack in our study likely minimised oedema even if fascial violation occurred and supported satisfaction alongside other multimodal measures. In this study, frequent postoperative follow-up, unrestricted wrist mobility, and uninterrupted access to patient-controlled analgesia also supported patient satisfaction in both groups. Among other postoperative outcomes, the anterior suprascapular nerve block group had a lower incidence of nausea and vomiting, independent of opioid use; this finding is clinically important and likely contributed to patient satisfaction. Higher satisfaction in the anterior block group may be related to less painful block administration, shorter application time, stronger analgesia, lower pain scores, lower opioid consumption, reduced rescue analgesia requirements, and lower rates of nausea and vomiting. In the posterior group, periosteal irritation during block administration, technical difficulty, lower analgesic effect, higher opioid consumption, and a greater nausea/vomiting burden may have reduced satisfaction. Limitations This study has several limitations. First, we limited follow-up to 24 hours; therefore, we could not provide data on chronic pain incidence or longer-term diaphragmatic function. Second, we did not assess postoperative shoulder range of motion or dynamic pain during movement, nor did we use objective pain-monitoring tools; these omissions may limit the interpretation of postoperative analgesia outcomes. Third, we did not perform brachial plexus examination or full upper-extremity dermatome assessment after the peripheral block, which limited our ability to evaluate trunk-level involvement for each approach. Fourth, we assessed diaphragmatic function only once, at 30 minutes after surgery. This timing reflected the early postoperative period, but a single DTF measurement at a single time point may miss transient or delayed dysfunction and underestimate phrenic nerve involvement. Fifth, we evaluated haemidiaphragmatic paralysis using only DTF and did not measure diaphragmatic excursion directly. DTF reflects contractility, and we measured it in line with expert consensus, but the absence of excursion data limited a comprehensive functional assessment. Finally, we conducted the study within a single surgical context (arthroscopic shoulder surgery under general anaesthesia), which may limit generalisability to other procedures or patient populations. Conclusion In patients undergoing arthroscopic shoulder surgery, a single-shot anterior suprascapular nerve block with 5 mL of local anaesthetic, as part of postoperative multimodal analgesia, was associated with better early postoperative analgesia, lower opioid consumption, fewer rescue analgesics, less nausea and vomiting, and higher patient satisfaction. However, between-group differences in cumulative opioid consumption were small at 6 and 12 hours, and 24-hour pain scores and cumulative opioid consumption were similar between groups, suggesting that a single-injection block with this volume offers limited-duration analgesia and may increase the need for additional analgesia. We found no between-group difference in diaphragmatic contractility, suggesting that the anterior approach with 5 mL of local anaesthetic may be considered unlikely to impair diaphragmatic function, despite its proximity to the nerve trunk. In arthroscopic shoulder surgery, the anterior approach may be a useful option for suprascapular nerve block, offering better early analgesia without an apparent effect on diaphragmatic function. Abbreviations ASA: American Society of Anesthesiologists Physical Status AUC: Area Under the Curve BIS: Bispectral Index BMI: Body Mass Index C5-C6: Cervical Nerve Roots C5-C6 CONSORT: Consolidated Standards of Reporting Trials DE: End-Expiratory Diaphragm Thickness DI: End-Inspiratory Diaphragm Thickness DTF: Diaphragm Thickness Fraction ΔDTF: Change in Diaphragm Thickness Fraction ED50: Effective Dose/Volume For 50% of Patients ED95: Effective Dose/Volume For 95% of Patients G: Gauge GA: Anterior Suprascapular Nerve Block Group GP: Posterior Suprascapular Nerve Block Group Hz: Hertz ISB: Interscalene Brachial Plexus Block mA: Milliampere MEV90: Minimum Effective Volume For 90% of Patients MHz: Megahertz mL: Millilitre mm: Millimetre MMT: Manual Muscle Testing PACU: Post-Anaesthesia Care Unit PCA: Patient-Controlled Analgesia PONV: Postoperative Nausea and Vomiting SpO2: Peripheral Oxygen Saturation SSN: Suprascapular Nerve SSNB: Suprascapular Nerve Block STB: Superior Trunk Block VAS: Visual Analogue Scale Declarations Ethics approval and consent to participate Ethical approval was obtained from the Ministry of Health Istanbul Medeniyet University Goztepe Training and Research Hospital Clinical Research Ethics Committee (Istanbul Medeniyet University, Istanbul, Turkey) (No: 2022/0155; date: 16 March 2022). The trial was prospectively registered at ClinicalTrials.gov (NCT05442814; registered on 18 April 2022; first posted on 1 July 2022). The first participant was enrolled on 11 July 2022. Written informed consent was obtained from all participants prior to enrolment. Consent for publication Not Applicable Competing interests The authors declare no competing interests. Funding The authors received no specific funding for this study. Funding: None Author Contribution Concept/Design: E.G.D. Data Collection, Analysis, Literature Search, Writing: All Author’s Final Approval: All Author’s Acknowledgement We thank Professor Yavuz Gurkan (Department of Anesthesiology and Reanimation, Koç University, Istanbul, Turkey) for his mentorship and guidance. We also thank R. Onur Oztornaci for statistical consultation, and Associate Professor Ismail Turkmen (Department of Orthopaedics and Traumatoloy, Klinikum Osnabrück, Osnabrück, Germany) for support during participant recruitment. Data Availability De-identified participant data will be shared with qualified researchers upon reasonable request, subject to approval by the relevant ethics committee and a signed data use agreement. References Leroux TS, Saltzman BM, Sumner SA, Maldoado-Rodriguez N, Agarwalla A, Ravi B, et al. Elective shoulder surgery in the opioid naïve: rates of and risk factors for long-term postoperative opioid use. Am J Sports Med. 2019;47(5):1051-6. doi: 10.1177/0363546519837516 El-Boghdadly K, Chin KJ, Chan VWS. Phrenic nerve palsy and regional anesthesia for shoulder surgery: anatomical, physiologic, and clinical considerations. Anesthesiology. 2017;127(1):173-91. doi: 10.1097/ALN.0000000000001668 Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia. 2010;65(6):608-24. doi: 10.1111/j.1365-2044.2009.06231.x Urmey WF, McDonald M. 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J Clin Anesth . 2025;105:111874. doi:10.1016/j.jclinane.2025.111874 Gautier P, Vandepitte C, Ramquet C, DeCoopman M, Xu D, Hadzic A. The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. Anesth Analg . 2011;113(4):951-955. doi:10.1213/ANE.0b013e31822b876f Riazi S, Carmichael N, Awad I, Holtby RM, McCartney CJ. Effect of local anaesthetic volume (20 vs 5 ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. Br J Anaesth . 2008;101(4):549-556. doi:10.1093/bja/aen229 Zhang J, Zhou Y, Ding P, et al. Optimizing the superior trunk block for arthroscopic shoulder surgery: a randomized, double-blind comparison of low- vs. conventional-dose ropivacaine on anesthesia, analgesia, and diaphragmatic function. BMC Anesthesiol . 2025;25(1):534. Published 2025 Oct 30. doi:10.1186/s12871-025-03409-z Kim DH, Lin Y, Beathe JC, et al. Superior Trunk Block: A Phrenic-sparing Alternative to the Interscalene Block: A Randomized Controlled Trial. Anesthesiology . 2019;131(3):521-533. doi:10.1097/ALN.0000000000002841 Fredrickson MJ, Price DJ. Analgesic effectiveness of ropivacaine 0.2% vs 0.4% via an ultrasound-guided C5-6 root/superior trunk perineural ambulatory catheter. Br J Anaesth . 2009;103(3):434-439. doi:10.1093/bja/aep195 Zhang JX, Wang K, Zhou YY, Li YH. Modified superior trunk block for anesthesia and analgesia in bilateral shoulder arthroscopy: A case report. Asian J Surg . 2023;46(2):971-972. doi:10.1016/j.asjsur.2022.07.082 Kim H, Han JU, Lee W, et al. Effects of Local Anesthetic Volume (Standard Versus Low) on Incidence of Hemidiaphragmatic Paralysis and Analgesic Quality for Ultrasound-Guided Superior Trunk Block After Arthroscopic Shoulder Surgery. Anesth Analg . 2021;133(5):1303-1310. doi:10.1213/ANE.0000000000005654 Wang K, Zhu H, Zhou Y, Gui S, Li Y. Maximum effective volume of 0.25% ropivacaine for preventing hemidiaphragmatic paralysis in 90% of patients undergoing shoulder arthroscopy: a biased coin up-and-down sequential allocation trial for ultrasound-guided superior trunk block. BMC Anesthesiol . 2025;25(1):381. Published 2025 Jul 30. doi:10.1186/s12871-025-03273-x Taha AM, Yurdi NA, Elahl MI, Abd-Elmaksoud AM. Diaphragm-sparing effect of the infraclavicular subomohyoid block vs low volume interscalene block: a randomized blinded study. Acta Anaesthesiol Scand. 2019;63(5):653-8. doi: 10.1111/aas.13322 Lim YC, Koo ZK, Ho VW, Chang SS, Manohara S, Tong QJ. Randomized, controlled trial comparing respiratory and analgesic effects of interscalene, anterior suprascapular, and posterior suprascapular nerve blocks for arthroscopic shoulder surgery. Korean J Anesthesiol. 2020;73(5):408-16. doi: 10.4097/kja.20141 Abdallah FW, Wijeysundera DN, Laupacis A, Brull R, Mocon A, Hussain N, et al. Subomohyoid anterior suprascapular block versus interscalene block for arthroscopic shoulder surgery: a multicenter randomized trial. Anesthesiology. 2020;132(5):839-53. doi: 10.1097/ALN.0000000000003132 Coşarcan SK, Doğan AT, Koyuncu Ö, Gürkan Y, Erçelen Ö. The minimum effective analgesic volume of 0.5% bupivacaine for ultrasound-guided anterior suprascapular nerve block. Cureus. 2022;14(11):e31350. doi: 10.7759/cureus.31350 Maikong N, Kantakam P, Sinthubua A, Mahakkanukrauh P, Tran DQ, Leurcharusmee P. Cadaveric study investigating the phrenic-sparing volume for anterior suprascapular nerve block. Reg Anesth Pain Med. 2021;46(9):769-72. doi: 10.1136/rapm-2021-102803 Auyong DB, Hanson NA, Joseph RS, Schmidt BE, Slee AE, Yuan SC. Comparison of anterior suprascapular, supraclavicular, and interscalene nerve block approaches for major outpatient arthroscopic shoulder surgery: a randomized, double-blind, noninferiority trial. Anesthesiology. 2018;129(1):47-57. doi: 10.1097/ALN.0000000000002208 Doğan AT, Coşarcan SK, Gürkan Y, Koyuncu Ö, Erçelen Ö, Demirhan M. Comparison of anterior suprascapular nerve block versus interscalene nerve block in terms of diaphragm paralysis in arthroscopic shoulder surgery: a prospective randomized clinical study. Acta Orthop Traumatol Turc. 2022;56(5):389-94. doi: 10.5152/j.aott.2022.22044 Rothe C, Steen-Hansen C, Lund J, Jenstrup MT, Lange KH. Ultrasound-guided block of the suprascapular nerve - a volunteer study of a new proximal approach. Acta Anaesthesiol Scand . 2014;58(10):1228-1232. doi:10.1111/aas.12392 Gupta K, Gupta M, Sabharwal N, Subramanium B, Belani KG, Chan V. Ultrasound-guided anterior suprascapular nerve block versus interscalene brachial plexus block for arthroscopic shoulder surgery: A randomised controlled study. Indian J Anaesth . 2023;67(7):595-602. doi:10.4103/ija.ija_126_23 Robles C, Berardone N, Orebaugh S. Effect of superior trunk block on diaphragm function and respiratory parameters after shoulder surgery. Reg Anesth Pain Med . 2022;47(3):167-170. doi:10.1136/rapm-2021-102962 Haaksma ME, Smit JM, Boussuges A, Demoule A, Dres M, Ferrari G, et al. EXpert consensus On Diaphragm UltraSonography in the critically ill (EXODUS): a Delphi consensus statement on the measurement of diaphragm ultrasound-derived parameters in a critical care setting. Crit Care. 2022;26(1):265. doi: 10.1186/s13054-022-03975-5 Jo Y, Oh C, Lee WY, et al. Randomised comparison between superior trunk and costoclavicular blocks for arthroscopic shoulder surgery: A noninferiority study. Eur J Anaesthesiol . 2022;39(10):810-817. doi:10.1097/EJA.0000000000001735 Dines JS. Shoulder surgery: tricks of the trade. In: Kehr P, Graftiaux AG, editors. Eur J Orthop Surg Traumatol. Cham: Springer; 2019. p. 30-545. Tables Table I. Patient demographic and clinical data GA(n=30) GP(n=30) P Value Age (yr), mean (SD) 53.7 (15.08) 55.6 (9.62) 0.842† Sex 0.301‡ Male, n (%) 17 (56.7%) 12 (40.0%) Female, n (%) 13 (43.3%) 18 (60.0%) BMI, kg/m² 27.96 (2.51) 27.62 (1.86) 0.329† ASA physical status 0.728‡ I, n (%) II, n (%) III, n (%) 5 (55.6%) 22 (51.2%) 3 (37.5%) 4 (44.4%) 21 (48.8%) 5 (62.5%) Surgical Side 0.579‡ Left, n (%) 8 (42.1%) 11 (57.9%) Right, n (%) 22 (53.7%) 19 (46.3%) Bankart repair surgery 0.038 ‡ * N/A, n (%) 26 (46.4%) 30 (53.6%) A, n (%) 4 (100%) 0 (0.00%) Subacromial decompression with/or not bursectomy 0.739‡ N/A, n (%) 6 (20%) 5 (16.7%) A, n (%) 24 (80%) 25 (83.3%) Infraspinatus repair 0,313‡ N/A, n (%) 29 (49.2%) 30 (50.8%) A, n (%) 1 (100%) 0 (0.00%) Supraspinatus repair 0.012 ‡ * N/A, n (%) 6 (100%) 0 (0.00%) A, n (%) 24 (44.4%) 30 (55.6%) Duration of surgery, (min), mean (SD) 106 (13.5) 101 (21.5) 0.381† †: Mann-Whitney U test, ‡: Chi-squared test *: p< 0,05, **: p<0.001, BMI: Body Mass Index, N/A: Not Applicable, A: Applicable, SD: standard deviation. Values are number (proportion) or mean (SD). Table II: Postoperative Shoulder Pain Assessment (VAS) GA (n=30) GP (n=30) Total d p VAS at 30 min Mean±SD 1,10±1,49 3,20±1,92 2,15±2,01 0,001** Median (Min-Max) 0 (0-4) 3 (0-7) 2 (0-7) %95 CI 0,54-1,66 2,48-3,92 1,63-2,67 VAS at 4 h Mean±SD 1,60±0,97 3,20±1,77 2,40±1,63 0,001** Median (Min-Max) 2 (0-4) 2 (0-7) 2 (0-7) %95 CI 1,24-1,96 2,54-3,86 1,98-2,82 VAS at 6 h Mean±SD 1,73±1,14 2,83±1,74 2,28±1,56 0,008* Median (Min-Max) 2 (0-4) 2 (0-8) 2 (0-8) %95 CI 1,31-2,16 2,18-3,48 1,88-2,69 VAS at 12 h Mean±SD 1,23±1,17 2,53±1,53 1,88±1,50 0,001** Median (Min-Max) 2 (0-4) 2 (0-7) 2 (0-7) %95 CI 0,80-1,67 1,96-3,10 1,50-2,27 VAS at 24 h Mean±SD 0,57±0,97 1,20±1,10 0,88±1,08 0,020 Median (Min-Max) 0 (0-3) 2 (0-4) 0 (0-4) %95 CI 0,20-0,93 0,79-1,61 0,61-1,16 f p 0,001** 0,001** Change ∆ 30 min – 4 h Mean±SD 0,50±1,59 0,00±2,27 0,25±1,96 0,367 ff p 0,111 0,967 30 min – 6 h Mean±SD 0,63±1,90 -0,37±2,62 0,13±2,33 0,057 ff p 0,045 0,624 30 min– 12 h Mean±SD 0,13±2,01 -0,67±2,63 -0,27±2,36 0,195 ff p 0,653 0,270 30 min– 24 h Mean±SD -0,53±1,98 -2,00±1,93 -1,27±2,07 0,009** ff p 0,165 0,001** d Mann Whitney-U Test, Between-group p values were Bonferroni-corrected (α-adj = 0.05/5 = 0.01) f Friedman Test & ffWilcoxon Signed-Rank Test with Bonferroni correction (post-hoc, k=4; α-adj=0.0125) **p<0,01 Table III: Opioid Consumption GA (n=30) GP (n=30) Total p Opioid consumption (mg) at 30 min Mean±SD 95% CI 0,89±1,12 0,47-1,31 2,25±1,67 1,63-2,87 1,57±1,57 1,16-1,98 d 0,001** Median (Min-Max) 0 (0-4) 2 (0-5) 1,5 (0-5) Opioid consumption (mg) at 4 h Mean±SD 95% CI 5,82±6,14 3,53-8,11 11,55±8,57 8,35-14,75 8,69±7,93 6,64-10,74 d 0,001** Median (Min-Max) 3,8 (0-23,5) 9 (0-30) 6 (0-30) Opioid consumption (mg) at 6 h Mean±SD 95% CI 9,75±8,42 6,61-12,90 15,30±10,6 11,34-19,26 12,53±9,90 9,97-15,08 d 0,025 Median (Min-Max) 7,5 (0-37,5) 12,3 (0-36) 9,2 (0-37,5) Opioid consumption (mg) at 12 h Mean±SD 95% CI 14,29±10,09 10,52-18,06 20,80±12,87 15,99-25,60 17,54±11,93 14,46-20,62 c 0,033 Median (Min-Max) 11,7 (0-40,5) 19,9 (1-50) 15 (0-50) Opioid consumption (mg) at 24 h Mean±SD 95% CI 20,56±13,68 15,45-25,67 25,89±13,88 20,70-31,07 23,22±13,93 19,63-26,82 c 0,140 Median (Min-Max) 19,4 (0-48,5) 23,6 (1-50) 23 (0-50) f p 0,001** 0,001** Change ∆ 30 min – 4 h Meant±SD 95%CI 4,93±5,69 2,81-7,06 9,30±8,36 6,18-12,42 7,12±7,42 5,20-9,03 d 0,017 ff p 0,001** 0,001** 30 min – 6 h Mean±SD 95% CI 8,86±8,15 5,82-11,91 13,05±10,48 9,14-16,97 10,96±9,54 8,49-13,42 d 0,108 ff p 0,001** 0,001** 30 min – 12 h Mean±SD 95% CI 13,40±9,86 9,72-17,08 18,55±12,94 13,71-23,38 15,97±11,70 12,95-18,99 d 0,126 ff p 0,001** 0,001** 30 min – 24 h Mean±SD 95% CI 19,67±13,65 14,58-24,77 23,64±14,13 18,36-28,91 21,65±13,92 18,06-25,25 d 0,322 ff p 0,001** 0,001** c Independent Samples-t Test d Mann Whitney-U Test Between-group comparisons across five postoperative time points were Bonferroni-corrected (α-adj=0.01). f Friedman Test & ffWilcoxon Signed-Rank Test with Bonferroni correction (post-hoc, k=4; α-adj=0.0125) **p<0,01 Table IV. Rescue analgesia Assessment GA (n=30) GP (n=30) P Rescue Analgesia 0.001**† N/A 27 (69.2%) 12 (30.8%) A 3 (14.3%) 18 (85.7%) Time to Rescue Analgesia 0.489† Pacu (1 st . h.) 2 (11.8%) 15 (88.2%) Patient’s Room (between 1 st -24 th h.) 1 (25%) 3 (75%) **: p<0.001, †: Chi-squared test, N/A: Not Applied, A: Applied Additional Declarations No competing interests reported. Supplementary Files CONSORT2010FlowDiagramBMC.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 08 May, 2026 Reviews received at journal 05 May, 2026 Reviewers agreed at journal 18 Apr, 2026 Reviews received at journal 12 Mar, 2026 Reviewers agreed at journal 07 Mar, 2026 Reviews received at journal 03 Mar, 2026 Reviewers agreed at journal 03 Mar, 2026 Reviewers invited by journal 02 Mar, 2026 Editor assigned by journal 02 Mar, 2026 Editor invited by journal 24 Feb, 2026 Submission checks completed at journal 23 Feb, 2026 First submitted to journal 23 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8865958","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":600145758,"identity":"4d3f8e26-4bca-4359-ba8b-cbfe17a27bff","order_by":0,"name":"Ebru Girgin Dinc","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYLACxgYGBn4QI6GAFC2SDSAtBqRoMTgAYhGjRT76+LUHH3fcS9x8fnXihwcGDPL8YgfwazE8l1NuOPNMceK2G283SwAdZjhzdgIBLT08adK8bQlALWc3gLQkGNwmRstfoJbNM85u/kGUFnke9mPSjEAtG/h7txFniwEPD5tk75kE4xk3eLdZJBhIEPaLfA/7M4mfOxJk+/vPbr75o8JGnl+akC0HeKBxIQFWKYFfOdiWBvYHEBb/AcKqR8EoGAWjYGQCAMQOR4LjS5y9AAAAAElFTkSuQmCC","orcid":"","institution":"Kosuyolu Yuksek Ihtisas Egitim ve Arastirma Hastanesi","correspondingAuthor":true,"prefix":"","firstName":"Ebru","middleName":"Girgin","lastName":"Dinc","suffix":""},{"id":600145759,"identity":"cb01d867-9f80-425e-93b3-28644857a34f","order_by":1,"name":"Mesure Gul Nihan OZDEN","email":"","orcid":"","institution":"Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"Mesure","middleName":"Gul Nihan","lastName":"OZDEN","suffix":""}],"badges":[],"createdAt":"2026-02-12 22:53:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8865958/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8865958/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104178760,"identity":"5aaba6e6-b2d2-4d53-b77b-d006c475f2e5","added_by":"auto","created_at":"2026-03-08 16:59:10","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":153855,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eUltrasound Image of Anterior and Posterior Approach for Suprascapular Nerve Block Procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure Ia illustrates the anterior approach for the suprascapular nerve block procedure (OHM: Omohyoid Muscle, SSN: Suprascapular Nerve, BP: Brachial Plexus, SA: Subclavian Artery). A 50-mm, 22-gauge insulated peripheral block needle was used.\u003c/p\u003e\n\u003cp\u003eFigure Ib illustrates the posterior approach for the suprascapular nerve block procedure (SSN, suprascapular nerve; TSSL, transverse suprascapular ligament; M., muscle). An 80-mm, 22-gauge insulated peripheral block needle was used.\u003c/p\u003e","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8865958/v1/2eacc22aaf41d43cd7d006c0.jpg"},{"id":104178761,"identity":"3e66b8f2-03f1-4d3e-9767-3ac4bea23e31","added_by":"auto","created_at":"2026-03-08 16:59:10","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":163466,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEvaluation of Diaphragm Thickening Function using Ultrasonography\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure II illustrates the evaluation of the diaphragm thickness fraction using ultrasonography with a linear probe.\u003c/p\u003e\n\u003cp\u003ea: Probe Position for Diaphragm Ultrasonography ZOA, zone of apposition; MCL, midclavicular line; AAL, anterior axillary line; MAL, mid-axillary line)\u003c/p\u003e\n\u003cp\u003eb: Evaluation of Diaphragm with B-mode ultrasonography\u003c/p\u003e\n\u003cp\u003ec: Evaluation of Diaphragm Thickness with M-mode ultrasonography Di: End-inspiratory diaphragmatic thickness; De: End-expiratory diaphragmatic thickness.\u003c/p\u003e","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8865958/v1/694c37050a164b8ce15aa25d.jpg"},{"id":104779590,"identity":"f4f546d3-8da0-49c8-b35e-17d99e2f0bb6","added_by":"auto","created_at":"2026-03-17 07:42:47","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":439507,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePain Management Assessment of Patients Who Underwent Anterior and Posterior Suprascapular Nerve Block Procedures.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Figure III, the x-axis represents time, the y-axis indicates the visual analogue scale (VAS) score for shoulder pain is presented in centimeters (cm), and opioid consumption is presented in milligrams (mg). Red represents Group Anterior, while blue represents Group Posterior. The primary outcome, postoperative shoulder pain assessed by VAS, was significantly lower in GA than in GP at 30 min, 4 h, 6 h, and 12 h, but not at 24 h after Bonferroni correction. VAS scores for postoperative shoulder pain were statistically significantly lower in GA than in GP at 30 min, 4 h, 6h, 12h, postoperatively (p=0.001, p=0.001, p=0.008, p=0.001, respectively). VAS scores for postoperative shoulder pain at 24 h postoperatively were lower in GA than in GP, but this difference did not remain statistically significant after Bonferroni correction for the five between-group time-point comparisons (α-adj=0.01; p=0.020). Cumulative opioid consumption was statistically significantly lower in GA than in GP at 30 min postoperatively and 4 h postoperatively (both p=0.001). At 6 h postoperatively and 12 h postoperatively, the between-group differences were smaller (p=0.024 and p=0.033, respectively). At 24 h postoperatively, cumulative opioid consumption was similar between groups (p=0.140; [Bonferroni correction for five time-point comparisons, α-adj=0.01]). In this analysis, quantitative variables were compared between groups using an independent-samples t-test when normally distributed and the Mann–Whitney U test when not normally distributed. For graphic design, Rplot05 was utilized in R version 4.3.1.\u003c/p\u003e","description":"","filename":"fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8865958/v1/a63bbfab06849a416be84e81.jpg"},{"id":104178763,"identity":"7a3ff6a7-0d9a-48c7-ad46-fa8845d33b4c","added_by":"auto","created_at":"2026-03-08 16:59:10","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":419605,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDiaphragm Thickening Function Assessment of Patients Who Underwent Anterior and Posterior Suprascapular Nerve Block Procedures.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Figure IV, the x-axis represents time, and the y-axis indicates diaphragmatic measurements, with diaphragmatic inspiratory thickness (DI) and expiratory thickness (DE) presented in millimetres (mm) and diaphragmatic thickening fraction (DTF) presented as a percentage (%). Red represents Group Anterior, while blue represents Group Posterior. Preoperative measurements were obtained before peripheral nerve block administration, and postoperative measurements were obtained at the 30th minute in the post-anaesthesia care unit. Measurements were performed at the zone of apposition using a linear ultrasound probe in M-mode. DI and DTF were significantly lower postoperatively than preoperatively (main effect of time: DI, F = 4.942, p = 0.030; DTF, F = 11.497, p = 0.001), whereas DE showed no significant change (F = 0.397, p = 0.531). No significant time-by-group interaction was observed for DI, DE, or DTF (DI, F \u0026lt; 0.001, p \u0026gt; 0.999; DE, F = 0.040, p = 0.646; DTF, F = 2.195, p = 0.144), and ΔDTF did not differ between groups (independent-samples t-test, p = 0.253). A two-way mixed (repeated-measures) ANOVA was used for the time and interaction effects. For graphic design, ggplot2 was utilised in R version 4.3.1.\u003c/p\u003e","description":"","filename":"fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8865958/v1/37744079f4ecee2d1de6509d.jpg"},{"id":104784055,"identity":"397b8bf1-3cb7-4253-ae8a-a3a0b960c1f3","added_by":"auto","created_at":"2026-03-17 08:04:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2814490,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8865958/v1/ee29eb96-4814-4990-ad7b-2b83f608badc.pdf"},{"id":104178762,"identity":"c0de98a9-f2ca-4e58-9b76-083ef530c1ba","added_by":"auto","created_at":"2026-03-08 16:59:10","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":54461,"visible":true,"origin":"","legend":"","description":"","filename":"CONSORT2010FlowDiagramBMC.docx","url":"https://assets-eu.researchsquare.com/files/rs-8865958/v1/cd20639bcb263196a13f5b9b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAnterior vs Posterior Approaches to Suprascapular Nerve Block in Arthroscopic Shoulder Surgery\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePostoperative shoulder pain is widely recognized as intense[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The interscalene brachial plexus block, commonly considered the gold standard for shoulder analgesia, frequently causes hemidiaphragmatic paralysis due to phrenic nerve involvement and regional spread of local anaesthetic [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Hemidiaphragmatic paralysis is also linked to a shared fibrous sheath between the brachial and cervical plexuses, which enables spread to the cervical fascia, even with low anaesthetic volumes[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. As reported by Siegenthaler et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and Laumonerie et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], the anterior suprascapular nerve block may serve as an alternative to avoid hemidiaphragmatic paralysis.\u003c/p\u003e \u003cp\u003eThis study hypothesized that the anterior and posterior approaches provide different levels of analgesia and that the risk of diaphragmatic paralysis relates to block volume. The two approaches were compared by evaluating diaphragmatic contractility.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003e This prospective, randomised, single-blind, two-parallel-group study was carried out in line with the Declaration of Helsinki (2013) and Good Clinical Practice, and was reported according to the CONSORT guidelines. Ethical approval was obtained from the Ministry of Health Istanbul Medeniyet University Goztepe Training and Research Hospital Clinical Research Ethics Committee (Istanbul Medeniyet University, Istanbul, Turkey) (No. 2022/0155; Date: 16 March 2022). The trial was prospectively registered at ClinicalTrials.gov (NCT05442814; registered on 18 April 2022; first posted on 1 July 2022). The first participant was enrolled on 11 July 2022. Written informed consent was obtained from all participants before enrolment. Participants were recruited between July 2022 and June 2023.\u003c/p\u003e \u003cp\u003eThe present study included participants who had undergone arthroscopic rotator cuff repair and Bankart repair. The inclusion criteria encompassed participants aged 18\u0026ndash;80 years, categorised according to the American Society of Anaesthesiologists\u0026rsquo; (ASA) physical status I\u0026ndash;III, and who provided both written and verbal consent. The primary exclusion criteria included coagulopathy, history of local anaesthetic drug allergy or toxicity, infection at the injection site, mental disorders, known or suggestive diaphragmatic paralysis, advanced organ failure, and pregnancy. Secondary exclusion criteria included conversion to open surgery, any adverse reaction during the study period, and missing opioid consumption data. Participants were randomised 1:1 to the anterior group (GA) or the posterior group (GP) using a computer-generated random sequence (Sealed Envelope; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.sealedenvelope.com\u003c/span\u003e\u003cspan address=\"http://www.sealedenvelope.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Allocation was concealed with sequentially numbered, opaque, sealed envelopes prepared in advance. The envelopes were held and retrieved by a member of staff who was not involved in performing the blocks. For each participant, the next envelope in sequence was opened immediately before the peripheral nerve block, after enrolment. Blinding procedures were implemented for all research participants, personnel involved in the outcome assessment, anaesthesia, surgery, nursing, and outcome assessor. Diaphragm ultrasonography was obtained by an experienced assessor blinded to the block technique. This manuscript adheres to the Consolidated Standards of Reporting Trials (CONSORT) guidelines.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOutcome Measures\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was the postoperative shoulder pain score measured on the Visual Analogue Scale (VAS) at 30 min, 4 h, 6 h, 12 h, and 24 h postoperatively. Secondary outcomes included opioid consumption, diaphragmatic thickening fraction, nausea, vomiting, and patient satisfaction.\u003c/p\u003e\n\u003ch3\u003ePeripheral Block Procedure\u003c/h3\u003e\n\u003cp\u003ePatient demographics, including age, sex, weight, body mass index (BMI), ASA physical status, and surgery side, were recorded after randomisation. Standard monitoring (electrocardiogram, SpO2, and non-invasive arterial blood pressure) was conducted during the peripheral block procedure. The suprascapular nerve block was performed in all patients in the designated peripheral nerve block area, 30 minutes before induction of general anaesthesia. Midazolam was administered intravenously at a dose of 1 mg to alleviate symptoms of anxiety. Prior to the block procedure, aseptic surgical techniques were employed. All peripheral nerve blocks were performed by a single experienced regional anaesthetist. Diaphragmatic ultrasound assessments were performed by an experienced operator blinded to the block technique.\u003c/p\u003e \u003cp\u003eBlock success was assessed 30 minutes following administration, before anaesthetic induction. Supraspinatus and infraspinatus strength were assessed on the blocked side. Supraspinatus function was tested using the open-can and empty-can manoeuvres, while infraspinatus function was evaluated with resisted external rotation with the shoulder in neutral and the external rotation lag sign. Strength was recorded on the \u003cem\u003e0\u0026ndash;5 Manual Muscle Testing (MMT) scale\u003c/em\u003e, where \u003cem\u003e0 is no muscle activation and 5 is normal strength\u003c/em\u003e. The suprascapular nerve block was deemed successful if any test showed a\u0026thinsp;\u0026ge;\u0026thinsp;1-grade reduction in MMT and/or a positive external rotation lag sign.\u003c/p\u003e\n\u003ch3\u003eAnterior Approach for Suprascapular Nerve Block\u003c/h3\u003e\n\u003cp\u003eIn the GA, participants were positioned with the head of the bed elevated at a 45-degree angle, opposite to the targeted area, and a shoulder support was placed beneath it. This was achieved by positioning the shoulder in adduction and the elbow in flexion on the side. Ultrasound (Samsung Ultrasound H60, Samsung, Seoul, Republic of Korea) clarity was optimised by focusing 0.5 cm below the omohyoid muscle using a linear probe with a 12.5\u0026ndash;16 MHz frequency. Following imaging of the brachial plexus, the search was directed laterally along the omohyoid muscle with a slight dorsal orientation at its lateral end. A 50-mm, 22-G insulated peripheral nerve block needle (Stimuplex\u0026reg; A; B. Braun, Melsungen, Germany) was inserted in plane under the omohyoid muscle, with the needle directed from posterolateral towards anteromedial (See Figure Ia). The hypoechoic suprascapular nerve, located approximately 1 cm below the skin, was reached by passing through the subfascia of a 2\u0026ndash;3-mm-thick omohyoid muscle. When the nerve stimulator (Plexygon Nerve Stimulator, Vygon GmbH, Aachen, Germany) induced external rotation in the infraspinatus muscle and abduction in the supraspinatus muscle within the range of 0.3\u0026ndash;0.5 mA using 0.1 ms, 2 Hz. Bupivacaine, at a concentration of 0.5% and a volume of 5 ml, was injected around the nerve. At the end of the procedure, the effects of the local anaesthetic were verified around the nerve.\u003c/p\u003e\n\u003ch3\u003ePosterior Approach for Suprascapular Nerve Block\u003c/h3\u003e\n\u003cp\u003eIn the GP, participants assumed a seated position, holding the opposite shoulder with the hand on the treated side while adducting the shoulder and flexing the elbow. With the participants in the sitting position, the operator stood behind the participant, and the ultrasound machine was positioned in front of the participant on the side of the block. Ultrasound guidance was provided using the same ultrasound system and a 10\u0026ndash;12.5 MHz linear probe on the side of the block. The upper medial part of the scapula was used to visualise the pleura in the suprascapular notch, just below the trapezius and supraspinatus muscles, from superficial to deep. The hyperechoic suprascapular nerve was identified under the transverse suprascapular ligament, approximately 4 cm from the skin. An 80-mm, 22-G insulated peripheral nerve block needle (Stimuplex\u0026reg; A; B. Braun, Melsungen, Germany) was inserted in plane from lateral to medial towards the target nerve (See Figure Ib). Once an appropriate motor response in the supraspinatus and infraspinatus muscles was obtained at 0.3\u0026ndash;0.5 mA (pulse width 0.1 ms; 2 Hz) using a nerve stimulator (Plexygon Nerve Stimulator, Vygon GmbH, Aachen, Germany), we injected 5 mL of 0.5% bupivacaine perineurally. At the end of the procedure, the spread of the local anaesthetic under the transverse suprascapular ligament was confirmed.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation of Diaphragm Thickening Function\u003c/h2\u003e \u003cp\u003e Diaphragmatic thickening fraction was measured in all participants using ultrasonography (Samsung Ultrasound H60, Samsung, Seoul, Republic of Korea) with a 10\u0026ndash;16 MHz linear probe at the zone of apposition along the anterior axillary line. After imaging the diaphragm, ribs, and chest wall in B-mode, M-mode images of diaphragm movements during calm and deep breathing were created. End-inspiratory (DI) and end-expiratory (DE) diaphragm thickness measurements were recorded (See Figure II). The preoperative baseline measurement was obtained before block administration by an experienced assessor blinded to the block technique, and the postoperative measurement was repeated by the same assessor at the same point at 30 minutes in the post-anaesthesia care unit (PACU). The diaphragm thickness fraction (DTF) was calculated using the formula \u003cem\u003eDTF = ([DI\u0026thinsp;\u0026minus;\u0026thinsp;DE]/ DE​) \u0026times; 100.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eIntraoperative Management\u003c/h3\u003e\n\u003cp\u003eFor general anaesthesia induction, fentanyl citrate (1 mcg/kg i.v.) and propofol (2 mg/kg i.v.) were administered. Rocuronium bromide (0.6 mg/kg i.v.) was used for neuromuscular blockade. Anaesthesia was maintained with sevoflurane at a minimum alveolar concentration at 1 and bispectral index (BIS) values (Medtronic, Dublin, Ireland) of 40\u0026ndash;50. When the BIS value was 40\u0026ndash;50, if there was a 20% increase in the arterial heart rate and/or systolic blood pressure compared to the initial value, pain was considered present. Perioperative administration of remifentanil was initiated at an infusion dose of 0.05 \u0026micro;g/kg/min, and the amount was titrated according to BIS and haemodynamic monitoring. Remifentanil consumption during surgery was documented.\u003c/p\u003e\n\u003ch3\u003eSurgical Procedures\u003c/h3\u003e\n\u003cp\u003eThree standard arthroscopic portals were used in all participants: a posterior viewing portal (approximately 2 cm inferior and 1 cm medial to the posterolateral acromial corner), an anterior working portal through the rotator interval slightly lateral to the coracoid process, and a lateral portal at the mid-acromial line for subacromial work. For rotator cuff repair, the lateral portal served as the main working portal for bursectomy and cuff repair, with anterolateral and/or posterolateral accessory portals added when required for suture passage and anchor placement. Subacromial decompression, with or without subacromial bursectomy, was performed when indicated. For Bankart repair, an anterosuperior and/or anteroinferior accessory portal was added as needed to mobilise the capsulolabral complex and facilitate suture-anchor placement along the anteroinferior glenoid. All procedures were performed by the same experienced orthopaedic surgeon.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePostoperative Pain Management\u003c/h2\u003e \u003cp\u003eAll participants were given paracetamol (15 mg/kg) intraoperatively and postoperatively. Postoperative pain control was maintained with morphine (0.5 mg/ml) in a 2-ml bolus with a 10-minute lock time using an intravenous patient-controlled analgesia (PCA) device (BodyGuard\u0026reg; 575Color Vision, Caesarea Medical Electronics GmbH). For patients with a VAS score of 4 or above for shoulder pain, rescue analgesia was provided with a 20-mg intravenous dose of tenoxicam. Additionally, ice was applied to the shoulders of all participants for 24 hours. In all participants, VAS scores for shoulder pain were evaluated at 30th minutes postoperatively and 4th, 6th, 12th, and 24th hours postoperatively, and the amount of opioid consumption was recorded. Postoperative nausea and vomiting were assessed using the postoperative nausea and vomiting (PONV) scale (0: \u003cem\u003enone\u003c/em\u003e; 1: \u003cem\u003emild nausea\u003c/em\u003e; 2: \u003cem\u003enausea\u003c/em\u003e; 3: \u003cem\u003evomiting once\u003c/em\u003e; 4: \u003cem\u003evomiting more than once\u003c/em\u003e). Ondansetron was administered intravenously at a 0.1 mg/kg dose if the score was 1 or higher. Patient satisfaction was evaluated using a 5-point Likert scale at 24 hours postoperatively (1\u0026thinsp;=\u0026thinsp;\u003cem\u003enot at all satisfied\u003c/em\u003e, 2\u0026thinsp;=\u0026thinsp;\u003cem\u003enot really satisfied\u003c/em\u003e, 3\u0026thinsp;=\u0026thinsp;\u003cem\u003eundecided\u003c/em\u003e, 4\u0026thinsp;=\u0026thinsp;\u003cem\u003esomewhat satisfied\u003c/em\u003e, 5\u0026thinsp;=\u0026thinsp;\u003cem\u003every much satisfied\u003c/em\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Evaluation\u003c/h2\u003e \u003cp\u003eSample size was calculated a priori for a superiority comparison, informed by internal estimates of variability (n\u0026thinsp;=\u0026thinsp;20; 10 participants per group). The primary endpoint was postoperative pain burden over 24 hours, expressed as the area under the VAS\u0026ndash;time curve (VAS AUC) from 0.5 to 24 hours, constructed from VAS scores recorded at 30 minutes, 4 hours, 6 hours, 12 hours, and 24 hours and computed using the trapezoidal rule. We prespecified a conservative minimal clinically important difference equivalent to a 0.8-point separation on the 0\u0026ndash;10 VAS maintained across the observation window, corresponding to an AUC difference of 18.8 VASxhours. Assuming a two-sided α of 0.05, 23 participants per group were required to achieve 90% power and 28 per group to achieve 95% power; with a 10% allowance for attrition, the planned enrolment was 26 per group (total n\u0026thinsp;=\u0026thinsp;52) for 90% power and 32 per group (total n\u0026thinsp;=\u0026thinsp;64) for 95% power.\u003c/p\u003e \u003cp\u003eThe Number Cruncher Statistical System software (version 2007; Kaysville, UT, USA) was used for statistical analysis. When evaluating the study data, descriptive statistical methods (mean, standard deviation, median, frequency, ratio, minimum, maximum, and confidence intervals) were used, along with the Shapiro\u0026ndash;Wilk test to assess the data distribution. For quantitative data, between-group comparisons were performed using an independent-samples t-test for normally distributed variables and the Mann\u0026ndash;Whitney U test for non-normally distributed variables. Spearman's correlation coefficient was used to determine the relationship between quantitative data. Repeated measures were analysed using a two-way mixed (repeated-measures) ANOVA to examine group, time, and group\u0026times;time effects; when the data were not suitable for a parametric analysis, non-parametric tests were used. Changes over time within each group were assessed using the Friedman test. If the Friedman test was significant, post hoc pairwise comparisons were performed using the Wilcoxon signed-rank test, with 30 minutes postoperatively as the reference time point.\u003c/p\u003e \u003cp\u003eSignificance was evaluated at p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 levels. Bonferroni correction was applied to account for multiple comparisons. For five between-group time-point comparisons, the Bonferroni-adjusted significance threshold was set at 0.01 (0.05/5). For post-hoc pairwise comparisons against the 30-minute postoperative reference (k\u0026thinsp;=\u0026thinsp;4), the Bonferroni-adjusted threshold was set at 0.0125 (0.05/4).\u003c/p\u003e \u003cp\u003eGraphical analyses of VAS scores, opioid consumption, and diaphragmatic thickness were performed using R (version 4.1.2; R Core Team, 2021) with the Rplot05 and ggplot2 packages.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eSixty-four participants who met the inclusion criteria were enrolled and randomized into two groups. Four participants were excluded from the final analysis in accordance with the secondary exclusion criteria. Two were excluded because of protocol deviations: one due to a postoperative malfunction of the patient-controlled analgesia (PCA) device, and one because the procedure required conversion to open surgery for a latissimus dorsi muscle flap. Of the remaining two, one developed an urticarial rash attributed to opioid administration, and the other reported chest pain requiring further clinical evaluation. As a result, 60 participants were included in the final analysis (See Consort Diagram).\u003c/p\u003e \u003cp\u003eBaseline demographic characteristics were similar between the groups; however, Bankart repair was performed only in the GA group (See Table I). Hemodynamic data and BIS values were also similar between the groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eThe primary outcome, postoperative shoulder pain assessed by VAS, was significantly lower in GA than in GP at 30 min, 4 h, 6 h, and 12 h, but not at 24 h after Bonferroni correction.\u003c/p\u003e \u003cp\u003eVAS scores for postoperative shoulder pain were statistically significantly lower in GA than in GP at 30 min, 4 h, 6h, 12h, postoperatively (p\u0026thinsp;=\u0026thinsp;0.001, p\u0026thinsp;=\u0026thinsp;0.001, p\u0026thinsp;=\u0026thinsp;0.008, p\u0026thinsp;=\u0026thinsp;0.001, respectively; see Figure III). VAS scores for postoperative shoulder pain at 24 h postoperatively were lower in GA than in GP, but this difference did not remain statistically significant after Bonferroni correction for the five between-group time-point comparisons (α-adj\u0026thinsp;=\u0026thinsp;0.01; p\u0026thinsp;=\u0026thinsp;0.020). Within-group changes over time were statistically significant in both groups, based on the Friedman test, GA p\u0026thinsp;=\u0026thinsp;0.001 and GP p\u0026thinsp;=\u0026thinsp;0.001. For post-hoc pairwise time comparisons, with 30 min postoperatively as the reference time point, Wilcoxon signed-rank tests with Bonferroni correction were applied; under this correction, the only statistically significant within-group comparison was found in GP between 30 min and 24 h postoperatively ([Wilcoxon\u0026ndash;Bonferroni p\u0026thinsp;=\u0026thinsp;0.001; k\u0026thinsp;=\u0026thinsp;4, α-adj\u0026thinsp;=\u0026thinsp;0.0125]; see Table II).\u003c/p\u003e \u003cp\u003ePerioperative opioid consumption was lower in the GA group than in the GP group (0.44 (1.06) mg vs 1.90 (3.54) mg; p\u0026thinsp;=\u0026thinsp;0.040).\u003c/p\u003e \u003cp\u003eCumulative opioid consumption was statistically significantly lower in GA than in GP at 30 min postoperatively and 4 h postoperatively (both p\u0026thinsp;=\u0026thinsp;0.001). At 6 h postoperatively and 12 h postoperatively, the between-group differences were smaller (p\u0026thinsp;=\u0026thinsp;0.024 and p\u0026thinsp;=\u0026thinsp;0.033, respectively). At 24 h postoperatively, cumulative opioid consumption was similar between groups (p\u0026thinsp;=\u0026thinsp;0.140; [Bonferroni correction for five time-point comparisons, α-adj\u0026thinsp;=\u0026thinsp;0.01]; see Table III and Figure III).\u003c/p\u003e \u003cp\u003eRescue analgesia use was also significantly lower in the GA than in the GP. Nevertheless, the distribution of rescue analgesia usage over time was similar between groups (See Table IV).\u003c/p\u003e \u003cp\u003eThe number of patients with a PONV score of 1 or more was significantly lower in the GA than in the GP ((n) 4 vs 12; p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003ePatient satisfaction scores was significantly lower in the GA than the GP [5 point Likert Patient Satisfaction Scale; 3 point= (GA(n)\u0026thinsp;=\u0026thinsp;0; GP(n)\u0026thinsp;=\u0026thinsp;11); 4 point= (GA(n)\u0026thinsp;=\u0026thinsp;1; GP(n)\u0026thinsp;=\u0026thinsp;13); 5 point= (GA(n)\u0026thinsp;=\u0026thinsp;29; GP(n)\u0026thinsp;=\u0026thinsp;6); (p\u0026thinsp;=\u0026thinsp;0.001)].\u003c/p\u003e \u003cp\u003eDI decreased from preoperative to postoperative measurements in both groups with a significant main effect of time (F\u0026thinsp;=\u0026thinsp;4.942, p\u0026thinsp;=\u0026thinsp;0.030), and no time-by-group interaction (F\u0026thinsp;\u0026lt;\u0026thinsp;0.001, p\u0026thinsp;\u0026gt;\u0026thinsp;0.999, see Figure IV).\u003c/p\u003e \u003cp\u003eDE showed no significant change over time effect (F\u0026thinsp;=\u0026thinsp;0.397, p\u0026thinsp;=\u0026thinsp;0.531), and no interaction with group (F\u0026thinsp;=\u0026thinsp;0.040, p\u0026thinsp;=\u0026thinsp;0.646, see Figure IV).\u003c/p\u003e \u003cp\u003eDTF decreased postoperatively in both groups with a significant main effect of time (F\u0026thinsp;=\u0026thinsp;11.497, p\u0026thinsp;=\u0026thinsp;0.001), and no time-by-group interaction (F\u0026thinsp;=\u0026thinsp;2.195, p\u0026thinsp;=\u0026thinsp;0.144, see Figure IV).\u003c/p\u003e \u003cp\u003eThe postoperative change in diaphragmatic thickening fraction DTF (ΔDTF) did not differ between groups (p\u0026thinsp;=\u0026thinsp;0.253, See Figure IV).\u003c/p\u003e \u003cp\u003eThere were no statistically significant correlations between groups for age, BMI, or preoperative Di, De and DTF values (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Similarly, there were no statistically significant differences in the ΔDTF values according to surgery side, asthma status, or sex (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eA weak correlation was observed between the ΔDTF and postoperative pain scores at the 30th minute (R\u0026sup2; = 0.047, p\u0026thinsp;=\u0026thinsp;0.097), indicating no statistically significant association with early postoperative pain intensity.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, a single-shot anterior suprascapular nerve block with 5 mL of local anaesthetic was associated with lower pain scores in the early postoperative period, reduced opioid requirements, less nausea and vomiting, and higher patient satisfaction. However, at 24 hours, VAS scores for postoperative shoulder pain and cumulative opioid consumption were similar between groups, suggesting that a single-injection block with this volume does not provide long-lasting analgesia. Small between-group differences at 6 and 12 hours postoperatively, which did not remain statistically significant after correction, point to a modest early opioid-sparing effect rather than a sustained benefit. We also found no between-group difference in diaphragmatic contractility.\u003c/p\u003e \u003cp\u003eThe suprascapular nerve typically arises from the upper brachial plexus (C5\u0026ndash;C6) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. It supplies motor innervation to the supraspinatus and infraspinatus muscles and contributes to articular afferents from the shoulder joints [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Cadaver mapping data show consistent suprascapular nerve innervation of the posterosuperior quadrant of the glenohumeral capsule, whilst branches of the axillary nerve innervate the posteroinferior and anteroinferior quadrants, and the superior nerve to the subscapularis more commonly innervates the anterosuperior quadrant [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Reports also describe innervation of the acromioclavicular joint through combined contributions from articular branches of the lateral pectoral nerve and the acromial branch of the suprascapular nerve [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This anatomical basis supports the analgesic efficacy of the suprascapular nerve block in shoulder surgery.\u003c/p\u003e \u003cp\u003eAlthough clinicians generally consider the suprascapular nerve\u0026rsquo;s cutaneous territory limited, reports on cutaneous contribution vary and remain inconsistent; in some individuals, sensory spread to the deltoid region may occur via a proximally arising cutaneous branch [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the supraclavicular fossa, the suprascapular nerve lies beneath the omohyoid muscle, which measures approximately 2\u0026ndash;3 mm in thickness. At this level, the nerve measures approximately 2\u0026ndash;3 mm in diameter and extends for about 10 mm. In this region, the distance between the suprascapular nerve and the brachial plexus ranges from 4 to 15 mm, with a mean of 9 mm [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This proximal course of the suprascapular nerve is clinically important during regional nerve block techniques.\u003c/p\u003e \u003cp\u003eFor shoulder analgesia, clinicians traditionally use the interscalene brachial plexus block (ISB), but it carries a high risk of haemidiaphragmatic paralysis [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Meta-analyses show that, compared with standard ISB, several strategies that aim to reduce phrenic nerve involvement [superior trunk block (STB), extrafascial or low-concentration ISB, supraclavicular block, and combined infraclavicular\u0026ndash;suprascapular techniques] reduce this risk; however, some ISB comparisons suggest that dose reduction may slightly worsen pain outcomes [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Although clinicians can perform ultrasound-guided ISB with low doses, published data indicate that even low volumes do not reliably spare the diaphragm and that clinically relevant rates of phrenic nerve paralysis may persist [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs a respiratory safer alternative to ISB, clinicians use superior trunk block (STB), an ultrasound-guided technique targeting the C5\u0026ndash;C6-derived superior trunk proximal to the branching point of the suprascapular nerve [\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Studies report that STB provides analgesia/anaesthesia comparable to ISB whilst markedly reducing haemidiaphragmatic paralysis and stellate ganglion-related adverse effects, without dyspnea [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Investigators have also described a more easily applied \u0026ldquo;sandwich-injection\u0026rdquo; modification that can provide effective bilateral shoulder anaesthesia/analgesia with minimal change in diaphragmatic excursion [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Dose-optimisation data suggest that haemidiaphragmatic dysfunction decreases as the administered dose decreases; however, these data also suggest shorter analgesia duration and a small increase in pain and opioid requirement later in the postoperative period [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Randomised studies and MEV90 calculations support this balance [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWithin this framework, suprascapular nerve block\u0026mdash;using different approaches\u0026mdash;has emerged as an option to reduce the risk of haemidiaphragmatic paralysis in arthroscopic rotator cuff surgery [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Using 15 mL, studies show that the anterior approach produces sensory and motor block levels like ISB, exerts a greater trunk-level effect than the posterior approach, and causes less respiratory involvement than ISB with either approach [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Another study using a similar volume also reported a superior trunk effect with the anterior approach [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Although clinicians can easily perform the anterior approach, it targets the nerve at a more proximal level after it separates from the trunk, raising questions about diaphragm-sparing volumes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Cadaver (MEV90 4.2 mL) and clinical effective-dose studies (ED50 2.646 mL and ED95 3.043 mL) report diaphragm-sparing dose ranges for the anterior approach; authors suggest that low volumes (4.2\u0026ndash;6 mL) may reduce diaphragmatic involvement and may lower rates of haemidiaphragmatic paralysis and dyspnoea compared with ISB [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31 CR32\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, the literature has not yet reported a direct clinical comparison between a low-volume anterior approach and the conventional posterior technique. We believe this study contributes to the literature by comparing anterior and posterior approaches using a 5 mL local anaesthetic volume.\u003c/p\u003e \u003cp\u003eThe proximity of the anterior suprascapular approach to the trunk may shift the effect of injected local anaesthetic from an isolated SSNB towards a partial brachial plexus/superior trunk effect. In the supraclavicular fossa, the suprascapular nerve (SSN) courses close to the brachial plexus, and cadaver work shows that injection at the anterior SSN injection site can produce a staining pattern that extends to the posterior and anterior divisions and to the middle trunk. Cadaver and experimental studies also support the possibility of spread via a dorsal route to a more proximal level towards the phrenic nerve [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies show that a truly selective proximal SSNB may be achievable only with very low volumes (1\u0026ndash;2 mL) and careful targeting; investigators confirmed target confirmation by visualising SSN separation under ultrasound and by nerve stimulation. These studies also emphasise that higher volumes can reduce selectivity [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAgainst this background, the anterior approach with 5 mL of local anaesthetic was associated with better early postoperative analgesia, lower opioid use, fewer rescue analgesics, and less need for rescue analgesia, which may reflect a clinical effect similar to a low-volume superior trunk block.\u003c/p\u003e \u003cp\u003eIn this study, the anterior group included all cases that underwent Bankart repair. If the anterior approach acted purely as a selective suprascapular nerve block, the quadrant-based innervation of the joint capsule would be expected to lead to higher early pain scores and higher analgesic requirements. However, in the early postoperative period, the anterior group had better analgesia and lower opioid use. This could be related to some proximal spread of local anaesthetic from the anterior injection site towards the superior trunk and its branches, which may have increased articular coverage.\u003c/p\u003e \u003cp\u003eHowever, postoperative 24-hour opioid consumption was similar between groups, and only small differences were observed at 6 and 12 hours, suggesting that a single-injection block with this volume did not provide sustained analgesia. Instead, the early advantage likely reflects initial block spread and perioperative multimodal analgesia dynamics.\u003c/p\u003e \u003cp\u003eLow-volume single-injection blocks may provide only limited-duration analgesia, potentially increasing the need for additional analgesia later. By contrast, adding adjuvants such as dexamethasone to the local anaesthetic may prolong block duration whilst preserving the low-volume strategy and may reduce later analgesic requirements [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn brachial plexus blocks, the timing of diaphragmatic assessment matters. Some data suggest that postoperative reassessment detects haemidiaphragmatic dysfunction more frequently than early post-block assessment, potentially due to cephalad spread of local anaesthetic over time [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Therefore, a single early measurement may underestimate diaphragmatic involvement. The Delphi consensus supports diaphragmatic excursion as a practical marker of dysfunction; however, it does not recommend a single cut-off for DTF and notes that thresholds may vary across populations [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In addition, a randomised STB\u0026ndash;ISB comparison defined haemidiaphragmatic paralysis as \u0026ldquo;complete\u0026rdquo; or \u0026ldquo;partial\u0026rdquo; using explicit ultrasonography criteria that combined excursion and DTF measurements [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In our study, we measured postoperative DTF at 30 minutes in the PACU. During this early period, residual anaesthetic effects, respiratory pattern variability, pain, and splinting can alter inspiratory effort and influence DTF. As a result, postoperative DTF variability may reflect early postoperative variability rather than true phrenic nerve paralysis. For this reason, we focused on analyses that accounted for baseline individual differences and reported both the overall pre\u0026ndash;post change within the cohort and the between-group comparison of change (group\u0026times;time interaction), rather than relying on a single postoperative value. In line with the Delphi consensus statement that respiratory pattern and effort can influence diaphragm ultrasound indices, we also evaluated whether pain explained changes in DTF. The weak association between pain and DTF change suggests that pain alone does not drive the change; instead, it may represent one component within a multifactorial early postoperative influence.\u003c/p\u003e \u003cp\u003ePrevious reports link deltoid fascia disruption during arthroscopy to lateral and posterior portals and identify it as a potential contributor to postoperative pain [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In this context, the 24-hour full-shoulder ice pack in our study likely minimised oedema even if fascial violation occurred and supported satisfaction alongside other multimodal measures.\u003c/p\u003e \u003cp\u003eIn this study, frequent postoperative follow-up, unrestricted wrist mobility, and uninterrupted access to patient-controlled analgesia also supported patient satisfaction in both groups.\u003c/p\u003e \u003cp\u003eAmong other postoperative outcomes, the anterior suprascapular nerve block group had a lower incidence of nausea and vomiting, independent of opioid use; this finding is clinically important and likely contributed to patient satisfaction.\u003c/p\u003e \u003cp\u003eHigher satisfaction in the anterior block group may be related to less painful block administration, shorter application time, stronger analgesia, lower pain scores, lower opioid consumption, reduced rescue analgesia requirements, and lower rates of nausea and vomiting. In the posterior group, periosteal irritation during block administration, technical difficulty, lower analgesic effect, higher opioid consumption, and a greater nausea/vomiting burden may have reduced satisfaction.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, we limited follow-up to 24 hours; therefore, we could not provide data on chronic pain incidence or longer-term diaphragmatic function.\u003c/p\u003e \u003cp\u003eSecond, we did not assess postoperative shoulder range of motion or dynamic pain during movement, nor did we use objective pain-monitoring tools; these omissions may limit the interpretation of postoperative analgesia outcomes.\u003c/p\u003e \u003cp\u003eThird, we did not perform brachial plexus examination or full upper-extremity dermatome assessment after the peripheral block, which limited our ability to evaluate trunk-level involvement for each approach.\u003c/p\u003e \u003cp\u003eFourth, we assessed diaphragmatic function only once, at 30 minutes after surgery. This timing reflected the early postoperative period, but a single DTF measurement at a single time point may miss transient or delayed dysfunction and underestimate phrenic nerve involvement.\u003c/p\u003e \u003cp\u003eFifth, we evaluated haemidiaphragmatic paralysis using only DTF and did not measure diaphragmatic excursion directly. DTF reflects contractility, and we measured it in line with expert consensus, but the absence of excursion data limited a comprehensive functional assessment.\u003c/p\u003e \u003cp\u003eFinally, we conducted the study within a single surgical context (arthroscopic shoulder surgery under general anaesthesia), which may limit generalisability to other procedures or patient populations.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn patients undergoing arthroscopic shoulder surgery, a single-shot anterior suprascapular nerve block with 5 mL of local anaesthetic, as part of postoperative multimodal analgesia, was associated with better early postoperative analgesia, lower opioid consumption, fewer rescue analgesics, less nausea and vomiting, and higher patient satisfaction. However, between-group differences in cumulative opioid consumption were small at 6 and 12 hours, and 24-hour pain scores and cumulative opioid consumption were similar between groups, suggesting that a single-injection block with this volume offers limited-duration analgesia and may increase the need for additional analgesia. We found no between-group difference in diaphragmatic contractility, suggesting that the anterior approach with 5 mL of local anaesthetic may be considered unlikely to impair diaphragmatic function, despite its proximity to the nerve trunk. In arthroscopic shoulder surgery, the anterior approach may be a useful option for suprascapular nerve block, offering better early analgesia without an apparent effect on diaphragmatic function.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul\u003e\n \u003cli\u003eASA: American Society of Anesthesiologists Physical Status\u003c/li\u003e\n \u003cli\u003eAUC: Area Under the Curve\u003c/li\u003e\n \u003cli\u003eBIS: Bispectral Index\u003c/li\u003e\n \u003cli\u003eBMI: Body Mass Index\u003c/li\u003e\n \u003cli\u003eC5-C6: Cervical Nerve Roots C5-C6\u003c/li\u003e\n \u003cli\u003eCONSORT: Consolidated Standards of Reporting Trials\u003c/li\u003e\n \u003cli\u003eDE: End-Expiratory Diaphragm Thickness\u003c/li\u003e\n \u003cli\u003eDI: End-Inspiratory Diaphragm Thickness\u003c/li\u003e\n \u003cli\u003eDTF: Diaphragm Thickness Fraction\u003c/li\u003e\n \u003cli\u003e\u0026Delta;DTF: Change in Diaphragm Thickness Fraction\u003c/li\u003e\n \u003cli\u003eED50: Effective Dose/Volume For 50% of Patients\u003c/li\u003e\n \u003cli\u003eED95: Effective Dose/Volume For 95% of Patients\u003c/li\u003e\n \u003cli\u003eG: Gauge\u003c/li\u003e\n \u003cli\u003eGA: Anterior Suprascapular Nerve Block Group\u003c/li\u003e\n \u003cli\u003eGP: Posterior Suprascapular Nerve Block Group\u003c/li\u003e\n \u003cli\u003eHz: Hertz\u003c/li\u003e\n \u003cli\u003eISB: Interscalene Brachial Plexus Block\u003c/li\u003e\n \u003cli\u003emA: Milliampere\u003c/li\u003e\n \u003cli\u003eMEV90: Minimum Effective Volume For 90% of Patients\u003c/li\u003e\n \u003cli\u003eMHz: Megahertz\u003c/li\u003e\n \u003cli\u003emL: Millilitre\u003c/li\u003e\n \u003cli\u003emm: Millimetre\u003c/li\u003e\n \u003cli\u003eMMT: Manual Muscle Testing\u003c/li\u003e\n \u003cli\u003ePACU: Post-Anaesthesia Care Unit\u003c/li\u003e\n \u003cli\u003ePCA: Patient-Controlled Analgesia\u003c/li\u003e\n \u003cli\u003ePONV: Postoperative Nausea and Vomiting\u003c/li\u003e\n \u003cli\u003eSpO2: Peripheral Oxygen Saturation\u003c/li\u003e\n \u003cli\u003eSSN: Suprascapular Nerve\u003c/li\u003e\n \u003cli\u003eSSNB: Suprascapular Nerve Block\u003c/li\u003e\n \u003cli\u003eSTB: Superior Trunk Block\u003c/li\u003e\n \u003cli\u003eVAS: Visual Analogue Scale\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e Ethical approval was obtained from the Ministry of Health Istanbul Medeniyet University Goztepe Training and Research Hospital Clinical Research Ethics Committee (Istanbul Medeniyet University, Istanbul, Turkey) (No: 2022/0155; date: 16 March 2022). The trial was prospectively registered at ClinicalTrials.gov (NCT05442814; registered on 18 April 2022; first posted on 1 July 2022). The first participant was enrolled on 11 July 2022. Written informed consent was obtained from all participants prior to enrolment.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot Applicable\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors received no specific funding for this study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConcept/Design: E.G.D. Data Collection, Analysis, Literature Search, Writing: All Author\u0026rsquo;s Final Approval: All Author\u0026rsquo;s\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe thank Professor Yavuz Gurkan (Department of Anesthesiology and Reanimation, Ko\u0026ccedil; University, Istanbul, Turkey) for his mentorship and guidance. We also thank R. Onur Oztornaci for statistical consultation, and Associate Professor Ismail Turkmen (Department of Orthopaedics and Traumatoloy, Klinikum Osnabr\u0026uuml;ck, Osnabr\u0026uuml;ck, Germany) for support during participant recruitment.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eDe-identified participant data will be shared with qualified researchers upon reasonable request, subject to approval by the relevant ethics committee and a signed data use agreement.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLeroux TS, Saltzman BM, Sumner SA, Maldoado-Rodriguez N, Agarwalla A, Ravi B, \u003cem\u003eet al.\u003c/em\u003e Elective shoulder surgery in the opioid na\u0026iuml;ve: rates of and risk factors for long-term postoperative opioid use. \u003cem\u003eAm J Sports Med.\u003c/em\u003e 2019;47(5):1051-6. doi: 10.1177/0363546519837516\u003c/li\u003e\n\u003cli\u003eEl-Boghdadly K, Chin KJ, Chan VWS. Phrenic nerve palsy and regional anesthesia for shoulder surgery: anatomical, physiologic, and clinical considerations. \u003cem\u003eAnesthesiology.\u003c/em\u003e 2017;127(1):173-91. doi: 10.1097/ALN.0000000000001668\u003c/li\u003e\n\u003cli\u003eFredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. \u003cem\u003eAnaesthesia.\u003c/em\u003e 2010;65(6):608-24. doi: 10.1111/j.1365-2044.2009.06231.x\u003c/li\u003e\n\u003cli\u003eUrmey WF, McDonald M. Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics. \u003cem\u003eAnesth Analg.\u003c/em\u003e 1992;74(3):352-7. doi: 10.1213/00000539-199203000-00006\u003c/li\u003e\n\u003cli\u003eSeltzer JL. Hoarseness and Horner\u0026rsquo;s syndrome after interscalene brachial plexus block. \u003cem\u003eAnesth Analg.\u003c/em\u003e 1977;56(4):585-6. doi: 10.1213/00000539-197707000-00033\u003c/li\u003e\n\u003cli\u003eWard ME. The interscalene approach to the brachial plexus. \u003cem\u003eAnaesthesia.\u003c/em\u003e 1974;29(2):147-57. doi: 10.1111/j.1365-2044.1974.tb00613.x\u003c/li\u003e\n\u003cli\u003eWinnie PA. Interscalene brachial plexus block. \u003cem\u003eAnesth Analg.\u003c/em\u003e 1970;49(3):455-66. doi: 10.1213/00000539-197005000-00029\u003c/li\u003e\n\u003cli\u003eSiegenthaler A, Moriggl B, Mlekusch S, Schliessbach J, Haug M, Curatolo M, \u003cem\u003eet al.\u003c/em\u003e Ultrasound-guided suprascapular nerve block, description of a novel supraclavicular approach. \u003cem\u003eReg Anesth Pain Med.\u003c/em\u003e 2012;37(3):325-8. doi: 10.1097/AAP.0b013e3182409168\u003c/li\u003e\n\u003cli\u003eLaumonerie P, Ferr\u0026eacute; F, Cances J, Tibbo ME, Roumigui\u0026eacute; M, Mansat P, \u003cem\u003eet al.\u003c/em\u003e Ultrasound-guided proximal suprascapular nerve block: a cadaveric study. \u003cem\u003eClin Anat.\u003c/em\u003e 2018;31(6):824-9. doi: 10.1002/ca.23199\u003c/li\u003e\n\u003cli\u003eHanna A. The SPA arrangement of the branches of the upper trunk of the brachial plexus: a correction of a longstanding misconception and a new diagram of the brachial plexus. \u003cem\u003eJ Neurosurg.\u003c/em\u003e 2016;125(2):350-4. doi: 10.3171/2015.5.JNS15367\u003c/li\u003e\n\u003cli\u003eDiwan S, Sathe D, Sabnis A, Mane P, Gupta A. Pathway from anterior suprascapular nerve block to the phrenic nerve: a cadaveric dye study. Anesth Pain Med (Seoul). 2025;20(2):175-182. doi:10.17085/apm.24142\u003c/li\u003e\n\u003cli\u003eTran J, Peng PWH, Agur AMR. Anatomical study of the innervation of glenohumeral and acromioclavicular joint capsules: implications for image-guided intervention. Reg Anesth Pain Med. Published online January 11, 2019. doi:10.1136/rapm-2018-100152\u003c/li\u003e\n\u003cli\u003ePirotesak S, Fallah N, Alruqaie R, Rodelo K, Asenjo JF, Aliste J. Costoclavicular brachial plexus block for shoulder surgery: a narrative review. Korean J Anesthesiol. 2025;78(6):513-523. doi:10.4097/kja.25422\u003c/li\u003e\n\u003cli\u003eAjmani ML. The cutaneous branch of the human suprascapular nerve. \u003cem\u003eJ Anat.\u003c/em\u003e 1994;185(Pt 2):439-42. PMID: 1166775\u003c/li\u003e\n\u003cli\u003eBattaglia PJ, Haun DW, Dooley K, Kettner NW. Sonographic measurement of the normal suprascapular nerve and omohyoid muscle. \u003cem\u003eMan Ther.\u003c/em\u003e 2014;19(2):165-8. doi: 10.1016/j.math.2013.12.005\u003c/li\u003e\n\u003cli\u003eUrmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. \u003cem\u003eAnesth Analg.\u003c/em\u003e 1991;72(4):498-503. doi: 10.1213/00000539-199104000-00014\u003c/li\u003e\n\u003cli\u003eVerelst P, Van Zundert A. Respiratory impact of analgesic strategies for shoulder surgery. \u003cem\u003eReg Anesth Pain Med.\u003c/em\u003e 2013;38(1):50-3. doi: 10.1097/AAP.0b013e318272195d\u003c/li\u003e\n\u003cli\u003eOliver-Fornies P, Aragon-Benedi C, Gomez Gomez R, et al. Hemidiaphragmatic paralysis after ultrasound-guided brachial plexus blocks for shoulder surgery: A systematic review and meta-analysis of randomized clinical trials. \u003cem\u003eJ Clin Anesth\u003c/em\u003e. 2025;105:111874. doi:10.1016/j.jclinane.2025.111874\u003c/li\u003e\n\u003cli\u003eGautier P, Vandepitte C, Ramquet C, DeCoopman M, Xu D, Hadzic A. The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. \u003cem\u003eAnesth Analg\u003c/em\u003e. 2011;113(4):951-955. doi:10.1213/ANE.0b013e31822b876f\u003c/li\u003e\n\u003cli\u003eRiazi S, Carmichael N, Awad I, Holtby RM, McCartney CJ. Effect of local anaesthetic volume (20 vs 5 ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. \u003cem\u003eBr J Anaesth\u003c/em\u003e. 2008;101(4):549-556. doi:10.1093/bja/aen229\u003c/li\u003e\n\u003cli\u003eZhang J, Zhou Y, Ding P, et al. Optimizing the superior trunk block for arthroscopic shoulder surgery: a randomized, double-blind comparison of low- vs. conventional-dose ropivacaine on anesthesia, analgesia, and diaphragmatic function. \u003cem\u003eBMC Anesthesiol\u003c/em\u003e. 2025;25(1):534. Published 2025 Oct 30. doi:10.1186/s12871-025-03409-z\u003c/li\u003e\n\u003cli\u003eKim DH, Lin Y, Beathe JC, et al. Superior Trunk Block: A Phrenic-sparing Alternative to the Interscalene Block: A Randomized Controlled Trial. \u003cem\u003eAnesthesiology\u003c/em\u003e. 2019;131(3):521-533. doi:10.1097/ALN.0000000000002841\u003c/li\u003e\n\u003cli\u003eFredrickson MJ, Price DJ. Analgesic effectiveness of ropivacaine 0.2% vs 0.4% via an ultrasound-guided C5-6 root/superior trunk perineural ambulatory catheter. \u003cem\u003eBr J Anaesth\u003c/em\u003e. 2009;103(3):434-439. doi:10.1093/bja/aep195\u003c/li\u003e\n\u003cli\u003eZhang JX, Wang K, Zhou YY, Li YH. Modified superior trunk block for anesthesia and analgesia in bilateral shoulder arthroscopy: A case report. \u003cem\u003eAsian J Surg\u003c/em\u003e. 2023;46(2):971-972. doi:10.1016/j.asjsur.2022.07.082\u003c/li\u003e\n\u003cli\u003eKim H, Han JU, Lee W, et al. Effects of Local Anesthetic Volume (Standard Versus Low) on Incidence of Hemidiaphragmatic Paralysis and Analgesic Quality for Ultrasound-Guided Superior Trunk Block After Arthroscopic Shoulder Surgery. \u003cem\u003eAnesth Analg\u003c/em\u003e. 2021;133(5):1303-1310. doi:10.1213/ANE.0000000000005654\u003c/li\u003e\n\u003cli\u003eWang K, Zhu H, Zhou Y, Gui S, Li Y. Maximum effective volume of 0.25% ropivacaine for preventing hemidiaphragmatic paralysis in 90% of patients undergoing shoulder arthroscopy: a biased coin up-and-down sequential allocation trial for ultrasound-guided superior trunk block. \u003cem\u003eBMC Anesthesiol\u003c/em\u003e. 2025;25(1):381. Published 2025 Jul 30. doi:10.1186/s12871-025-03273-x\u003c/li\u003e\n\u003cli\u003eTaha AM, Yurdi NA, Elahl MI, Abd-Elmaksoud AM. Diaphragm-sparing effect of the infraclavicular subomohyoid block vs low volume interscalene block: a randomized blinded study. \u003cem\u003eActa Anaesthesiol Scand.\u003c/em\u003e 2019;63(5):653-8. doi: 10.1111/aas.13322\u003c/li\u003e\n\u003cli\u003eLim YC, Koo ZK, Ho VW, Chang SS, Manohara S, Tong QJ. Randomized, controlled trial comparing respiratory and analgesic effects of interscalene, anterior suprascapular, and posterior suprascapular nerve blocks for arthroscopic shoulder surgery. \u003cem\u003eKorean J Anesthesiol.\u003c/em\u003e 2020;73(5):408-16. doi: 10.4097/kja.20141\u003c/li\u003e\n\u003cli\u003eAbdallah FW, Wijeysundera DN, Laupacis A, Brull R, Mocon A, Hussain N, \u003cem\u003eet al.\u003c/em\u003e Subomohyoid anterior suprascapular block versus interscalene block for arthroscopic shoulder surgery: a multicenter randomized trial. \u003cem\u003eAnesthesiology.\u003c/em\u003e 2020;132(5):839-53. doi: 10.1097/ALN.0000000000003132\u003c/li\u003e\n\u003cli\u003eCoşarcan SK, Doğan AT, Koyuncu \u0026Ouml;, G\u0026uuml;rkan Y, Er\u0026ccedil;elen \u0026Ouml;. The minimum effective analgesic volume of 0.5% bupivacaine for ultrasound-guided anterior suprascapular nerve block. \u003cem\u003eCureus.\u003c/em\u003e 2022;14(11):e31350. doi: 10.7759/cureus.31350\u003c/li\u003e\n\u003cli\u003eMaikong N, Kantakam P, Sinthubua A, Mahakkanukrauh P, Tran DQ, Leurcharusmee P. Cadaveric study investigating the phrenic-sparing volume for anterior suprascapular nerve block. \u003cem\u003eReg Anesth Pain Med.\u003c/em\u003e 2021;46(9):769-72. doi: 10.1136/rapm-2021-102803\u003c/li\u003e\n\u003cli\u003eAuyong DB, Hanson NA, Joseph RS, Schmidt BE, Slee AE, Yuan SC. Comparison of anterior suprascapular, supraclavicular, and interscalene nerve block approaches for major outpatient arthroscopic shoulder surgery: a randomized, double-blind, noninferiority trial. \u003cem\u003eAnesthesiology.\u003c/em\u003e 2018;129(1):47-57. doi: 10.1097/ALN.0000000000002208\u003c/li\u003e\n\u003cli\u003eDoğan AT, Coşarcan SK, G\u0026uuml;rkan Y, Koyuncu \u0026Ouml;, Er\u0026ccedil;elen \u0026Ouml;, Demirhan M. Comparison of anterior suprascapular nerve block versus interscalene nerve block in terms of diaphragm paralysis in arthroscopic shoulder surgery: a prospective randomized clinical study. \u003cem\u003eActa Orthop Traumatol Turc.\u003c/em\u003e 2022;56(5):389-94. doi: 10.5152/j.aott.2022.22044\u003c/li\u003e\n\u003cli\u003eRothe C, Steen-Hansen C, Lund J, Jenstrup MT, Lange KH. Ultrasound-guided block of the suprascapular nerve - a volunteer study of a new proximal approach. \u003cem\u003eActa Anaesthesiol Scand\u003c/em\u003e. 2014;58(10):1228-1232. doi:10.1111/aas.12392\u003c/li\u003e\n\u003cli\u003eGupta K, Gupta M, Sabharwal N, Subramanium B, Belani KG, Chan V. Ultrasound-guided anterior suprascapular nerve block versus interscalene brachial plexus block for arthroscopic shoulder surgery: A randomised controlled study. \u003cem\u003eIndian J Anaesth\u003c/em\u003e. 2023;67(7):595-602. doi:10.4103/ija.ija_126_23\u003c/li\u003e\n\u003cli\u003eRobles C, Berardone N, Orebaugh S. Effect of superior trunk block on diaphragm function and respiratory parameters after shoulder surgery. \u003cem\u003eReg Anesth Pain Med\u003c/em\u003e. 2022;47(3):167-170. doi:10.1136/rapm-2021-102962\u003c/li\u003e\n\u003cli\u003eHaaksma ME, Smit JM, Boussuges A, Demoule A, Dres M, Ferrari G, \u003cem\u003eet al.\u003c/em\u003e EXpert consensus On Diaphragm UltraSonography in the critically ill (EXODUS): a Delphi consensus statement on the measurement of diaphragm ultrasound-derived parameters in a critical care setting. \u003cem\u003eCrit Care.\u003c/em\u003e 2022;26(1):265. doi: 10.1186/s13054-022-03975-5\u003c/li\u003e\n\u003cli\u003eJo Y, Oh C, Lee WY, et al. Randomised comparison between superior trunk and costoclavicular blocks for arthroscopic shoulder surgery: A noninferiority study. \u003cem\u003eEur J Anaesthesiol\u003c/em\u003e. 2022;39(10):810-817. doi:10.1097/EJA.0000000000001735\u003c/li\u003e\n\u003cli\u003eDines JS. Shoulder surgery: tricks of the trade. In: Kehr P, Graftiaux AG, editors. \u003cem\u003eEur J Orthop Surg Traumatol.\u003c/em\u003e Cham: Springer; 2019. p. 30-545.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable I. Patient demographic and clinical data\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"96%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 1.713%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.0137%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGA(n=30) \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGP(n=30)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (yr), mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e53.7 (15.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e55.6 (9.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; 0.842\u0026dagger; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; 0.301\u0026Dagger;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003eMale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e17 (56.7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e12 (40.0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003eFemale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e13 (43.3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e18 (60.0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI, kg/m\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e27.96 (2.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e27.62 (1.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; 0.329\u0026dagger;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASA physical status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; 0.728\u0026Dagger;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003eI, n (%)\u003c/p\u003e\n \u003cp\u003eII, \u0026nbsp;n (%)\u003c/p\u003e\n \u003cp\u003eIII, \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e\u0026nbsp;5 (55.6%)\u003c/p\u003e\n \u003cp\u003e22 (51.2%)\u003c/p\u003e\n \u003cp\u003e3 (37.5%) \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp;4 (44.4%)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21 (48.8%)\u003c/p\u003e\n \u003cp\u003e5 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical Side\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp;0.579\u0026Dagger; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003eLeft, \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e\u0026nbsp;8 (42.1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e11 (57.9%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003eRight, \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e22 (53.7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e19 (46.3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBankart repair surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;0.038\u003c/strong\u003e\u0026Dagger;\u003cstrong\u003e*\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003eN/A, \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e26 (46.4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp;30 (53.6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003eA, \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e\u0026nbsp;4 (100%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp;0 (0.00%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubacromial\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edecompression with/or not bursectomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; 0.739\u0026Dagger;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003eN/A, \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e6 (20%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp;5 (16.7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003eA, \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e24 (80%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e25 (83.3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfraspinatus repair\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; 0,313\u0026Dagger;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003eN/A, \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e29 (49.2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp;30 (50.8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003eA, \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e\u0026nbsp;1 (100%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp;0 (0.00%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupraspinatus repair\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;0.012\u003c/strong\u003e\u0026Dagger;\u003cstrong\u003e*\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003eN/A, \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e\u0026nbsp;6 (100%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp;0 (0.00%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003eA, \u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e24 (44.4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e\u0026nbsp;30 (55.6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 30.7267%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of surgery, (min), mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0593%;\"\u003e\n \u003cp\u003e106 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5968%;\"\u003e\n \u003cp\u003e101 (21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3486%;\"\u003e\n \u003cp\u003e0.381\u0026dagger;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u0026dagger;: Mann-Whitney U test, \u0026Dagger;: Chi-squared test *: p\u0026lt; 0,05, **: p\u0026lt;0.001,\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBMI: Body Mass Index, N/A: Not Applicable, A: Applicable, SD: standard deviation. Values are number (proportion) or mean (SD).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable II: Postoperative Shoulder Pain Assessment (VAS)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGA (n=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGP (n=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003csup\u003ed\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVAS at 30 min\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1,10\u0026plusmn;1,49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e3,20\u0026plusmn;1,92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2,15\u0026plusmn;2,01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMedian (Min-Max)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0 (0-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e3 (0-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2 (0-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003e%95 CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e0,54-1,66\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e2,48-3,92\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e1,63-2,67\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVAS at 4 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1,60\u0026plusmn;0,97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e3,20\u0026plusmn;1,77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2,40\u0026plusmn;1,63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMedian (Min-Max)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2 (0-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2 (0-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2 (0-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003e%95 CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e1,24-1,96\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e2,54-3,86\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e1,98-2,82\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVAS at 6 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1,73\u0026plusmn;1,14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2,83\u0026plusmn;1,74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2,28\u0026plusmn;1,56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,008*\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMedian (Min-Max)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2 (0-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2 (0-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2 (0-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003e%95 CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e1,31-2,16\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e2,18-3,48\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e1,88-2,69\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVAS at 12 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1,23\u0026plusmn;1,17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2,53\u0026plusmn;1,53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1,88\u0026plusmn;1,50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMedian (Min-Max)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2 (0-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2 (0-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2 (0-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003e%95 CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e0,80-1,67\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e1,96-3,10\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e1,50-2,27\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVAS at 24 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0,57\u0026plusmn;0,97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1,20\u0026plusmn;1,10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0,88\u0026plusmn;1,08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,020\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMedian (Min-Max)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0 (0-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2 (0-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0 (0-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003e%95 CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e0,20-0,93\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e0,79-1,61\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cem\u003e0,61-1,16\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003ef\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange ∆\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30 min \u0026ndash; 4 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0,50\u0026plusmn;1,59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0,00\u0026plusmn;2,27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0,25\u0026plusmn;1,96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,367\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003eff\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,111\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,967\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30 min \u0026ndash; 6 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0,63\u0026plusmn;1,90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-0,37\u0026plusmn;2,62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0,13\u0026plusmn;2,33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,057\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003eff\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,045\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,624\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30 min\u0026ndash; 12 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e0,13\u0026plusmn;2,01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-0,67\u0026plusmn;2,63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-0,27\u0026plusmn;2,36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,195\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003eff\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,653\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,270\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30 min\u0026ndash; 24 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-0,53\u0026plusmn;1,98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-2,00\u0026plusmn;1,93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e-1,27\u0026plusmn;2,07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,009**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003eff\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,165\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003ed\u003c/sup\u003e\u003c/em\u003e\u003cem\u003eMann Whitney-U Test,\u0026nbsp;\u003c/em\u003e\u003cem\u003eBetween-group p values were Bonferroni-corrected (\u0026alpha;-adj = 0.05/5 = 0.01)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003ef\u003c/sup\u003e\u003c/em\u003e\u003cem\u003eFriedman Test \u0026amp; ffWilcoxon Signed-Rank Test\u0026nbsp;\u003c/em\u003ewith Bonferroni correction (post-hoc, k=4; \u0026alpha;-adj=0.0125)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e**p\u0026lt;0,01\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eTable III: Opioid Consumption\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGA (n=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGP (n=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpioid consumption (mg) at 30 min\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0,89\u0026plusmn;1,12\u003c/p\u003e\n \u003cp\u003e0,47-1,31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2,25\u0026plusmn;1,67\u003c/p\u003e\n \u003cp\u003e1,63-2,87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e1,57\u0026plusmn;1,57\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e1,16-1,98\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003ed\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMedian (Min-Max)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e0 (0-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2 (0-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e1,5 (0-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpioid consumption (mg) at 4 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5,82\u0026plusmn;6,14\u003c/p\u003e\n \u003cp\u003e3,53-8,11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e11,55\u0026plusmn;8,57\u003c/p\u003e\n \u003cp\u003e8,35-14,75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e8,69\u0026plusmn;7,93\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e6,64-10,74\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003ed\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMedian (Min-Max)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3,8 (0-23,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e9 (0-30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e6 (0-30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpioid consumption (mg) at 6 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e9,75\u0026plusmn;8,42\u003c/p\u003e\n \u003cp\u003e6,61-12,90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e15,30\u0026plusmn;10,6\u003c/p\u003e\n \u003cp\u003e11,34-19,26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e12,53\u0026plusmn;9,90\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e9,97-15,08\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003ed\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e0,025\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMedian (Min-Max)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7,5 (0-37,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e12,3 (0-36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e9,2 (0-37,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpioid consumption (mg) at 12 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e14,29\u0026plusmn;10,09\u003c/p\u003e\n \u003cp\u003e10,52-18,06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e20,80\u0026plusmn;12,87\u003c/p\u003e\n \u003cp\u003e15,99-25,60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e17,54\u0026plusmn;11,93\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e14,46-20,62\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003ec\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e0,033\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMedian (Min-Max)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e11,7 (0-40,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e19,9 (1-50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e15 (0-50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpioid consumption (mg) at 24 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e20,56\u0026plusmn;13,68\u003c/p\u003e\n \u003cp\u003e15,45-25,67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e25,89\u0026plusmn;13,88\u003c/p\u003e\n \u003cp\u003e20,70-31,07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e23,22\u0026plusmn;13,93\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e19,63-26,82\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003ec\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e0,140\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMedian (Min-Max)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e19,4 (0-48,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e23,6 (1-50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e23 (0-50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003ef\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange ∆\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30 min \u0026ndash; 4 h\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeant\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e95%CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4,93\u0026plusmn;5,69\u003c/p\u003e\n \u003cp\u003e2,81-7,06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e9,30\u0026plusmn;8,36\u003c/p\u003e\n \u003cp\u003e6,18-12,42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cem\u003e7,12\u0026plusmn;7,42\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e5,20-9,03\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003ed\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e0,017\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003eff\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30 min \u0026ndash; 6 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18px;\"\u003e\n \u003cp\u003e8,86\u0026plusmn;8,15\u003c/p\u003e\n \u003cp\u003e5,82-11,91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e13,05\u0026plusmn;10,48\u003c/p\u003e\n \u003cp\u003e9,14-16,97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cem\u003e10,96\u0026plusmn;9,54\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e8,49-13,42\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003ed\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e0,108\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003eff\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30 min \u0026ndash; 12 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18px;\"\u003e\n \u003cp\u003e13,40\u0026plusmn;9,86\u003c/p\u003e\n \u003cp\u003e9,72-17,08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e18,55\u0026plusmn;12,94\u003c/p\u003e\n \u003cp\u003e13,71-23,38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cem\u003e15,97\u0026plusmn;11,70\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e12,95-18,99\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003ed\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e0,126\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003eff\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30 min \u0026ndash; 24 h\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cem\u003eMean\u0026plusmn;SD\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e95% CI\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cem\u003e19,67\u0026plusmn;13,65\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e14,58-24,77\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cem\u003e23,64\u0026plusmn;14,13\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e18,36-28,91\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cem\u003e21,65\u0026plusmn;13,92\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e18,06-25,25\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003ed\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e0,322\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003eff\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e0,001**\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003ec\u003c/sup\u003e\u003c/em\u003e\u003cem\u003eIndependent Samples-t Test\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003ed\u003c/sup\u003e\u003c/em\u003e\u003cem\u003eMann Whitney-U Test\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBetween-group comparisons across five postoperative time points were Bonferroni-corrected (\u0026alpha;-adj=0.01).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003ef\u003c/sup\u003e\u003c/em\u003e\u003cem\u003eFriedman Test \u0026amp; ffWilcoxon Signed-Rank Test\u0026nbsp;\u003c/em\u003ewith Bonferroni correction (post-hoc, k=4; \u0026alpha;-adj=0.0125)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e**p\u0026lt;0,01\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable IV. Rescue analgesia Assessment\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.5416%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6573%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eGA\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;(n=30)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.3752%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eGP\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;(n=30)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.426%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.5416%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eRescue Analgesia\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6573%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.3752%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.426%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.001**\u0026dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.5416%;\"\u003e\n \u003cp\u003e\u003cem\u003eN/A\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6573%;\"\u003e\n \u003cp\u003e\u003cem\u003e27 (69.2%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.3752%;\"\u003e\n \u003cp\u003e\u003cem\u003e12 (30.8%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.426%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.5416%;\"\u003e\n \u003cp\u003e\u003cem\u003eA\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6573%;\"\u003e\n \u003cp\u003e\u003cem\u003e3 (14.3%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.3752%;\"\u003e\n \u003cp\u003e\u003cem\u003e18 (85.7%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.426%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.5416%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTime to Rescue Analgesia\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6573%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.3752%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.426%;\"\u003e\n \u003cp\u003e\u003cem\u003e0.489\u0026dagger;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.5416%;\"\u003e\n \u003cp\u003e\u003cem\u003ePacu (1\u003csup\u003est\u003c/sup\u003e. h.)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6573%;\"\u003e\n \u003cp\u003e\u003cem\u003e2 (11.8%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.3752%;\"\u003e\n \u003cp\u003e\u003cem\u003e15 (88.2%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.426%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.5416%;\"\u003e\n \u003cp\u003e\u003cem\u003ePatient\u0026rsquo;s Room (between 1\u003csup\u003est\u003c/sup\u003e-24\u003csup\u003eth\u003c/sup\u003e h.)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.6573%;\"\u003e\n \u003cp\u003e\u003cem\u003e1 (25%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.3752%;\"\u003e\n \u003cp\u003e\u003cem\u003e3 (75%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22.426%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e**: p\u0026lt;0.001, \u0026dagger;:\u0026nbsp;\u003c/em\u003e\u003cem\u003eChi-squared test, N/A: Not Applied, A: Applied\u003c/em\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Diaphragm, Nerve Block, Phrenic Nerve, Shoulder Pain, Ultrasonography","lastPublishedDoi":"10.21203/rs.3.rs-8865958/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8865958/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSuprascapular nerve block (SSNB) can provide effective postoperative shoulder analgesia with less risk of phrenic nerve involvement than the interscalene brachial plexus block. We compared the analgesic efficacy and diaphragmatic effects of anterior and posterior SSNB using 5 mL of local anaesthetic in arthroscopic shoulder surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a prospective, randomised, single-blind, two-parallel-group study of ASA I-III participants aged 18\u0026ndash;80 years undergoing elective arthroscopic shoulder surgery recruited between July 2022 to June 2023. Participants underwent ultrasound-guided SSNB anterior and posterior approaches with 5 mL volume of 0.5% concentration bupivacaine. Randomisation was conducted 1:1 using a computer programme, and allocation was implemented using the sealed-envelope method. Participants and outcome assessors were blinded to group assignment. The primary outcome was the postoperative shoulder pain score measured on the Visual Analogue Scale (VAS) at 30 min, 4 h, 6 h, 12 h, and 24 h postoperatively. Secondary outcomes included opioid consumption, diaphragmatic thickening fraction, nausea, vomiting, and patient satisfaction.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSixty participants were randomised and analysed (30 per group). Postoperative pain (primary outcome) measured by VAS was lower in the anterior approach (GA) than the posterior approach (GP) at 30 min, 4 h, 6 h, and 12 h (p\u0026thinsp;=\u0026thinsp;0.001, p\u0026thinsp;=\u0026thinsp;0.001, p\u0026thinsp;=\u0026thinsp;0.008, p\u0026thinsp;=\u0026thinsp;0.001). Pain at 24 h was not statistically different after Bonferroni correction (α-adj\u0026thinsp;=\u0026thinsp;0.01; p\u0026thinsp;=\u0026thinsp;0.020). GA had lower cumulative opioid consumption at 30 min and 4 h (both p\u0026thinsp;=\u0026thinsp;0.001). Opioid use was similar at 24 h (p\u0026thinsp;=\u0026thinsp;0.140). Patient satisfaction was higher in GA (p\u0026thinsp;=\u0026thinsp;0.001). PONV was lower in GA (p\u0026thinsp;=\u0026thinsp;0.001). DTF did not differ between groups (p\u0026thinsp;=\u0026thinsp;0.253). No serious adverse events related to the block occurred. One participant developed an urticarial rash from opioid administration, and one participant reported chest pain requiring further evaluation.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn arthroscopic shoulder surgery, the anterior approach may be a useful option for suprascapular nerve block, offering better early analgesia without an apparent effect on diaphragmatic function.\u003c/p\u003e\u003ch2\u003eEthics approval and consent to participate:\u003c/h2\u003e \u003cp\u003e Ministry of Health Istanbul Medeniyet University Goztepe Training and Research Hospital Clinical Research Ethics Committee (Istanbul Medeniyet University, Istanbul, Turkey) (No: 2022/0155; Date: 16 March 2022)\u003c/p\u003e\u003ch2\u003eLevels of Evidence:\u003c/h2\u003e \u003cp\u003eLEVEL II, Prospective Comparative Study\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eClinicalTrials.gov, NCT05442814. Prospectively registered on 18 April 2022 (first posted on 1 July 2022; first participant enrolled on 11 July 2022).\u003c/p\u003e","manuscriptTitle":"Anterior vs Posterior Approaches to Suprascapular Nerve Block in Arthroscopic Shoulder Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 16:59:06","doi":"10.21203/rs.3.rs-8865958/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-08T06:19:20+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T12:53:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"137689900708804685090518474275827933353","date":"2026-04-18T21:09:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T11:40:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149791632006614708798120335403427013270","date":"2026-03-08T02:52:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-03T17:14:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"92775962887974949388241510233105834236","date":"2026-03-03T05:17:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-02T15:31:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-02T15:26:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-24T10:27:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-23T20:02:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2026-02-23T19:57:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"81d1d914-ae12-4cbb-8f40-462ea5df7d41","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-08T06:19:20+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T12:53:28+00:00","index":44,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T06:25:49+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-08 16:59:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8865958","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8865958","identity":"rs-8865958","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}