Brachial Plexus Block, Shoulder Pain
Conditions
Keywords
8th cervical nerve root block
Brief summary
This study evaluates the effects of selective 8th cervical nerve root block during interscalene brachial plexus block on the relief of pain intensity upon the introduction of a posterior portal during arthroscopic shoulder surgery. The 5th to 7th cervical nerve roots will be blocked in half of participants, while the 5th to 8th cervical nerve roots will be blocked in the other half.
Detailed description
By blocking only the 5th to 7th cervical nerve blocks, conventional interscalene brachial plexus block spares the 8th cervical and 1st thoracic dermatomes which innervate the posterior aspect of the shoulder. To visualize the shoulder joint space during shoulder arthroscopic surgery, the introduction of a posterior portal is essential. However, conventional interscalene brachial plexus block cannot effectively relieve the pain caused by its insertion due to sparing of the 8th cervical and 1st thoracic dermatomes. The addition of the 8th cervical nerve root block to conventional interscalene brachial plexus block decreases pain intensity upon the introduction of a posterior portal.
Interventions
PROCEDUREConventional interscalene block
Under ultrasound guidance, the 5th to 7th cervical nerve roots are blocked.
PROCEDUREInterscalene block with C8 root block
Under ultrasound guidance, the 5th to 8th cervical nerve roots are blocked.
Placement of 25 to 30 ml of 0.75% ropivacaine around the cervical nerve roots
Sponsors
Daegu Catholic University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists physical status 1 and 2 * Arthroscopic shoulder surgery under interscalene brachial plexus block
Exclusion criteria
* Patient refusal * Contralateral hemidiaphragmatic paralysis or paresis * Contralateral vocal cord palsy * Severe pulmonary restrictive disease * Coagulopathy * Allergy to local anesthetics or history of allergic shock * Difficulty communicating with medical personnel * Peripheral neuropathy or neurologic sequelae on the operative limb
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity upon the introduction of a posterior portal | 50 minutes after interscalene block | 0, 1, and 2 represent no pain, mild pain, and severe pain, respectively. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Motor blockade | 30 minutes after interscalene block | Motor blockade of the radial, ulnar, median, musculocutaneous, and axillary nerves graded from 0 to 2 (0 = complete block, 1 = partial block, and 2 = no block) |
| Ipsilateral hemidiaphragmatic blockade | Before interscalene block and 30 minutes after interscalene block | Extent of a reduction in the amplitude of excursion of the diaphragm on the vertical axis of the M-mode wave under M-mode ultrasound evaluation |
| Horner's syndrome | Before interscalene block and 30 minutes after interscalene block | The extent of a reduction in the ipsilateral pupil size measured by a pupillometer Presence or absence of ptosis |
| Pulmonary function test | Before interscalene block and 30 minutes after interscalene block | Forced expiratory volume at one second (FEV1) and FEV1/forced vital capacity before and 30 minutes after the end of local anesthetic injection |
| Complications related with interscalene block | 24 hours | Presence or absence of vascular puncture, local anesthetic systemic toxicity, pneumothorax, and paresthesia |
| Numerical pain rating score at admission to postanesthetic care unit | 5 minutes | Numerical pain rating score ranging from 0 to 10 (0 = no pain, 10 = worst pain imaginable) at admission to postanesthetic care unit |
| Numerical pain rating score at discharge from postanesthetic care unit | 30 minutes | Numerical pain rating score ranging from 0 to 10 (0 = no pain, 10 = worst pain imaginable) at discharge from postanesthetic care unit |
| Numerical pain rating score between 6 and 12 hours after surgery | 6 and 12 hours | Numerical pain rating score ranging from 0 to 10 (0 = no pain, 10 = worst pain imaginable) between 6 and 12 hours after surgery |
| Sensory blockade | 30 minutes after interscalene block | C5 to T1 dermatomal blockade graded from 0 to 2 (0 = no cold sensation, 1 = reduced cold sensation, and 2 = normal cold sensation) by applying ice to the shoulder |
| Worst numerical pain rating score | 24 hours | Worst numerical pain rating score ranging from 0 to 10 (0 = no pain, 10 = worst pain imaginable) during 24 hours after surgery |
| Postoperative hour when pain starts to be felt | 24 hours | Time at regression of anesthesia which starts to cause postoperative pain during 24 hours after surgery |
| Patient's satisfaction about surgical anesthesia and postoperative analgesia | 24 hours | Likert scale consisting of very dissatisfied, dissatisfied, unsure, satisfied, and very satisfied |
| Dose of postoperative analgesic use | 24 hours | Cumulative dose of analgesic required for postoperative analgesia during 24 hours after surgery |
| Frequency of postoperative analgesic use | 24 hours | Frequency of analgesic use during 24 hours after surgery |
| Dose of intraoperative analgesic use | 2 hours | Cumulative dose of analgesic to supplement incomplete surgical anesthesia |
| Frequency of intraoperative analgesic use | 2 hours | Frequency of analgesic use to supplement incomplete surgical anesthesia |
| Conversion into general anesthesia | 1 hour | Number of patients whose regional anesthesia is converted into general anesthesia due to incomplete surgical anesthesia provided by the regional anesthesia |
| Numerical pain rating score 24 hours after surgery | 24 hours | Numerical pain rating score ranging from 0 to 10 (0 = no pain, 10 = worst pain imaginable) 24 hours after surgery |
Countries
South Korea
Outcome results
None listed