None listed
Conditions
Brief summary
Shoulder arthroscopy is commonly performed and postoperative pain can be substantial. The superior trunk block provides effective pain relief but may still impair diaphragm function in some patients. Although this is often well tolerated in healthy individuals, it may be clinically important in older or frail patients and those with pre-existing respiratory disease. Selective shoulder nerve blocks have been developed to target the nerves supplying the shoulder while potentially preserving diaphragm function, but clinical evidence supporting this approach remains limited. This randomised feasibility trial will compare the SAXIPec technique with the superior trunk block in adults undergoing elective shoulder arthroscopy. The primary aim is to determine whether a larger randomised controlled trial can be successfully conducted by assessing recruitment, successful delivery of the allocated intervention and completeness of follow-up. The study will also collect preliminary information on pain, quality of recovery, opioid consumption and diaphragm function to inform the design of a future definitive trial.
Interventions
Arm 1:
Participants undergoing elective unilateral shoulder arthroscopy will receive the allocated ultrasound-guided regional anaesthesia immediately before induction of general anaesthesia in the anaesthetic bay. All nerve blocks will be performed by consultant anaesthetists experienced in ultrasound-guided regional anaesthesia using a sterile technique in keeping with ANZCA guidelines, and single-use 80mm needles with ropivacaine 0.5% administered by syringe under real-time ultrasound guidance
Arm 1: Participants undergoing elective unilateral shoulder arthroscopy will receive the allocated ultrasound-guided regional anaesthesia immediately before induction of general anaesthesia in the anaesthetic bay. All nerve blocks will be performed by consultant anaesthetists experienced in ultrasound-guided regional anaesthesia using a sterile technique in keeping with ANZCA guidelines, and single-use 80mm needles with ropivacaine 0.5% administered by syringe under real-time ultrasound guidance. SAXIPec group: ultrasound-guided posterior suprascapular nerve block (10 mL 0.5% ropivacaine), trans-quadrangular space axillary nerve block (7 mL 0.5% ropivacaine), and lateral pectoral nerve block (3 mL 0.5% ropivacaine). General anaesthesia will then be induced immediately after completion of the regional block. Surgery will proceed according to routine practice. General anaesthesia will otherwise be at the discretion of the treating anaesthetist, while postoperative multimodal analgesia will be standardised according to institutional protocol. Intervention fidelity will be assessed using study-specific REDCap electronic data collection forms completed by the treating anaesthetist performing the nerve block(s). The forms document completion of the allocated intervention, local anaesthetic volumes administered, and any protocol deviations or crossover. Access to the REDCap database is restricted to authorised study investigators.
Sponsors
St. Vincent's Hospital Melbourne
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adults aged 18 years or older with American Society of Anesthesiologists (ASA) physical status I–III undergoing elective unilateral shoulder arthroscopy, able to provide written informed consent and complete study questionnaires.
Exclusion criteria
Contraindications to peripheral nerve block or local anaesthetic allergy; body mass index >45 kg/m²; pre-existing peripheral neuropathy or coagulation disorder; chronic pain or regular opioid use; significant systemic disease including moderate to severe pulmonary disease, chronic liver disease, congestive heart failure or renal impairment; known contralateral diaphragmatic dysfunction or previous phrenic nerve injury; impaired capacity to provide informed consent or complete study questionnaires; or emergency surgery.
Outcome results
None listed