Surgery
Conditions
Keywords
Shoulder surgery, Local regional anesthesia
Brief summary
Shoulder surgery is a source of intense postoperative pain that justifies the use of opioids. In this context, analgesia provided by locoregional anesthesia (ALR) improves the rehabilitation of patients by reducing the length of hospital stay and morphine consumption. Thus anesthesia of the brachial plexus interscalene (interscalene block or BIS) is considered as the reference technique for the management of post-operative pain after shoulder surgery. It is however provider of hemi-diaphragmatic paralysis (PhD) in nearly 100% of cases. Thus, this technique is usually avoided in patients with respiratory insufficiency. In arthroscopic shoulder surgery, the development of a suprascapular and axillary nerve (SSAX) conjugate block appears to be an effective analgesic alternative in this context.
Detailed description
Two ultrasound-guided approaches of the suprascapular nerve (anterior and posterior approaches) have been described in the literature. From an anatomical point of view, the anterior approach could expose patients to the risk of ipsilateral PhD by phrenic nerve block secondary to diffusion of the local anesthetic into the supraclavicular region. By measuring the diaphragm excursion during a sniff test, ultrasound allows reliable and reproducible analysis of the diaphragm function. No study has evaluated the incidence of PhD after ultrasound block of the suprascapular nerve. Knowing the influence of the approach on this complication could be of major interest in this context.
Interventions
PROCEDUREanterior SSAX
block of the suprascapular nerve block for shoulder surgery by anterior way
PROCEDUREposterior SSAX
block of the suprascapular nerve block for shoulder surgery by posterior way
Sponsors
University Hospital, Toulouse
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* to benefit from scheduled arthroscopic surgery of the shoulder under general anesthesia * Affiliate or beneficiary of a social security scheme * Having signed the informed consent
Exclusion criteria
* the existence of contralateral diaphragmatic paralysis * pre-existing respiratory insufficiency * impossibility of performing diaphragmatic ultrasound * the patient's refusal * the existence of major spontaneous or acquired haemostatic disorders * an infection at the point of puncture * allergy to local anesthetics * Pregnant or likely to be pregnant * Patients under protection of the adults (guardianship, curators or safeguard of justice) * Patients whose cognitive state does not allow assessment by the scales used
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| change in diaphragmatic excursion | 30 minutes | measured on ultrasound between the 30th minute after SSAX and the basal state (i.e. prior to regional anesthesia). The diaphragmatic excursion is the distance traveled by the diaphragm between the functional residual capacity (CRF) and the forced inspiration during a rapid voluntary sniffing (or sniff test). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PhD over time | Baseline, 30 minutes, 4 hours and 8 hours | diaphragmatic excursion by a repeated ultrasound during a sniff test in the basal state (ie before regional anesthesia), then 30 minutes, 4 hours and finally 8 hours after realization of the ALR |
Other
| Measure | Time frame | Description |
|---|---|---|
| Pain evaluation by ENS | Baseline, 4 hours and 24 hours | Evaluation of the pain by simple numerical scale (ENS from 0 to 10) in the post-interventional surveillance room (SSPI, at the 4th hour) and at the 24th hour |
| Morphine consumption | until 24 hours | Evaluation of the morphine consumption in the post-interventional surveillance room (during 24 hours after the SSP) |
| patient's satisfaction | 24 hours | Evaluation of the patient's satisfaction with the French Evaluation du Vécu de l'Anesthésie LocoRégionale (EVAN-LR) score |
Countries
France
Outcome results
None listed