Shoulder Pain
Conditions
Keywords
ISPB, Brachial Plexus Block, Anesthesia, Pain Management, Surgery
Brief summary
Interscalene block (ISB) consistently demonstrates superior pain relief after shoulder surgery. However, patients can experience complications such as blurred vision, hoarseness and shortness of breath with the standard volumes of local anesthetic used in contemporary practice. Patients with respiratory diseases are precluded because of the potential effects on respiration. However, they are then exposed to the risks of general anesthesia and opioid medications which can also have detrimental effects on respiration. Ultrasound guided ISB can reduce the local anesthetic volume required to produce anesthesia for shoulder surgery; this may reduce the complications from ISB to allow patients previously unable to benefit to have this technique, such as patients with obesity and respiratory disease. In order to do so the investigators will use an up-down methodology to find the minimum volume of local anesthetic to provide sufficient anesthesia for shoulder surgery.
Interventions
PROCEDUREDose of of ropivacaine 0.75% used in block procedure
Sponsors
The Physicians' Services Incorporated Foundation
Sunnybrook Health Sciences Centre
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Patients undergoing elective arthroscopic shoulder surgery in the sitting position * Patients aged \>=18 and \<=75 years * ASA I-III
Exclusion criteria
* Patient refusal for surgery under ISBPB with sedation * Lack of capacity to provide informed consent * Pre-existing COPD, unstable asthma or diaphragmatic dysfunction * Coagulopathy * Infection at injection site * Allergy to local anesthetics * Opioid tolerance (\>30mg oral morphine or equivalent/day for \>1 week) * BMI\>40 * Inability to complete questionnaires and assessments (consent, follow-up phone call) due to language barrier * Pregnancy or lactation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| MEAV95 of ropivacaine 0.75% | 30 minutes post injection | to determine the MEAV95 of ropivacaine 0.75% at the level of root C5-6 using the dose-finding protocol. The success of surgical anesthesia is defined by the presence of sensory blockade (no sensation/score of 0 to pinprick testing) 30 minutes post injection of local anesthetic |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Bedside spirometry | 30 minutes post block, 30min post-surgery, and 2 hours post surgery | Bedside spirometry (FEV1, FVC, PEFR) and Pulse oximetry on air: at baseline, 30 minutes post block, 30min post-surgery, and 2 hours post surgery |
| Diaphragmatic excursion | 30 minutes post block, and 2 hours post surgery | Diaphragmatic excursion: ultrasound examination at baseline, 30 minutes post block, and 2 hours post surgery |
| Complications | 30 minutes | Complications: Hoarseness, Horner's syndrome, intravascular injection |
| Motor blockade | 30 minutes | The C5 myotome covers the deltoid muscle (the most powerful motion being shoulder abduction) and the biceps brachii muscle. Biceps brachii is also innervated by C6. Therefore, motor blockade will be assessed by testing shoulder abduction and forearm flexion. Motor function will be classified as present (any movement) or absent (no movement) |
| Total opioid consumption until discharge | 24 hours (at discharge) | Total opioid consumption until discharge |
| Opioid related side effects | 24 hours (at discharge) | Opioid related side effects: nausea, vomiting, dizziness, pruritis |
| Time to first analgesic use | within 24 hours post surgery | Time to first analgesic use in hospital and after discharge |
| Pain Scores on Visual Analog Scale | at baseline, after surgery at 30 and 60 minutes in the PACU, and at 1 hour intervals until discharge | Visual analog scale (VAS) - at baseline, after surgery at 30 and 60 minutes in the PACU, and at 1 hour intervals until discharge |
Countries
Canada
Contacts
Primary ContactColin McCartney
Outcome results
None listed