Background: Pain after trauma is the most common symptom report by patients. Specific

protocols have been developed to treat pain in order to prevent posttramatic stress disorder.  

Ultrasound imaging has been shown to help perform various peripheral blocks by visualising 

the nerves and the adiacent anatomical structures and does not required electrical stimulation. 

Interscalenic plexus block is a common technique used for  traumatic shoulder surgery..

Methods:112 patients ASA I-III undergoing shoulder surgery after a traumatic event, were 

prospectively enroled in 2 groups. They were randomly allocated to receive neurostimulated 

interscalenic block groupNS =56 patients and ultrasound guided interscalenic block 

groupUS=56 patients  for shoulder surgery. Premedication included sufentanil 0.1mcg/bw. 

Aditional propofol at patient request for more comfort 0.2-0.5mg/bw and a resque dose of 

sufentanil 0.05-0.1mcg/bw. The comfort score used to evaluate patients satisfaction during 

interscalenic block performance include three criteria: maximal pain intensity using VAS 

score (0-100), the number of unpleasant events and patients satisfaction (unsatisfied, 

acceptable, satisfied, very satisfied). The comfort score was calculated as the sum of each 

criterion with atributed value of 0 or 1: VAS (<30/100, 1; >30/100, 0), number of unplesant 

events  (0,1; >1,0) and satisfaction (satisfied and very satisfied, 1; acceptable or unsatisfied,0).  

Primary endpoint was patient comfort score. Secondary endpoints were time to perform the 

block, complications, success rate, aditional premedications.

Results: In the group NS 35% (21/56) were confortable respectively to 74% ( 42/56) in US 

group,  p<0.01. Time to achive the interscalenic block was better in group US compared to 

group NS, p<0.05. Rescue preoperative medication was higher in group NS compared to 

group US, p<0.01. No statistical differeces were regardind succes rate and complications.

Preop medic Gr. NS͓ Gr. US 

propofol 20±5.2 8±2.4 

sufentanil 10±3.5 5±1.7 

P<0.01͓

Conclusion: This study demonstrated that ultrasound technique is less painful and offer more 

comfort than neurostimulating method for traumatic upper arm injured patients. Electrical 

stimuli was considered the most unpleasant event.

Neurostimulation vs. ultrasound guided interscalenic block for traumatic upper shoulder surgery - a prospective randomised trial assesing patient comfort and satisfaction