Interscalene Block Enhances Wound Healing, Modulates Immune Response, and Accelerates Recovery After Shoulder Surgery

Abstract

Background Shoulder surgeries are among the most painful orthopedic procedures, and optimal perioperative management is crucial for recovery. Interscalene block (ISB) is widely used for analgesia, yet its effects on wound healing and postoperative immune function remain poorly defined. This study aimed to determine whether ISB enhances wound healing, modulates immune responses, and improves recovery outcomes compared with general anesthesia (GA).

Methods This study is a prospective, randomized, controlled clinical trial designed to evaluate the effects of interscalene block on wound healing and postoperative immune response in patients undergoing elective open shoulder surgery.Thirty-four patients undergoing elective rotator cuff repair were randomly assigned to GA (n = 17) or ISB (n = 17) via sealed-envelope randomization. Wound healing was assessed using the Toronto Symptom Assessment System for Wounds (TSAS-W) on postoperative days 5 and 14. Immune response was evaluated by platelet count and serum levels of IL-1, IL-2, TNF-α, EGF, TGF-β, and PDGF at baseline, 24, and 48 hours postoperatively. Secondary outcomes included postoperative pain (VAS), mobilization times, analgesic consumption, and incidence of nausea and vomiting. Statistical analyses incorporated parametric and non-parametric tests, repeated measures analysis, chi-square/Fisher’s exact tests, Bonferroni correction, and effect size calculations (p < 0.05).

Results ISB significantly accelerated wound healing, with lower TSAS-W scores on days 5 and 14 compared with GA (p < 0.05). Postoperative platelet counts and levels of IL-1, IL-2, EGF, TGF-β, and PDGF were significantly higher in the ISB group at 24 and 48 hours (p < 0.05), whereas TNF-α remained unchanged. ISB also provided superior analgesia, reflected by lower VAS scores, reduced analgesic consumption, faster mobilization, and decreased incidence of postoperative nausea and vomiting (all p < 0.05).

Conclusion Interscalene block not only provides effective analgesia but also enhances wound healing and modulates immune function, promoting faster and safer recovery after shoulder surgery. These findings support ISB as a multifaceted perioperative intervention with benefits beyond pain control.

Competing Interest Statement

The authors have declared no competing interest.

Clinical Trial

IRB Number: Clinical Research Ethics Committee of Van Yüzüncü Yıl University (13.06.2022-14). Research Registration Number: ClinicalTrials.gov (NCT05499897)

Clinical Protocols

https://www.yyu.edu.tr/Birimler/14/sayfalar/11359

Funding Statement

Yes

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

IRB Number: Clinical Research Ethics Committee of Van Yüzüncü Yıl University (13.06.2022-14). Research Registration Number: ClinicalTrials.gov (NCT05499897)

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

Data cannot be shared publicly because of Patient confidentiality. Data are available from the Van Yuzuncu Yil University Institutional Data Access / Ethics Committee (contact via Şevin Kartal- Van Yuzuncu Yil University Ethical commitee assistant)) for researchers who meet the criteria for access to confidential data. The data underlying the results presented in the study are available from (Van Yuzuncu Yil University Department of Anesthesiology records).

https://www.yyu.edu.tr/Birimler/330

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