Anesthesia, Local, Phrenic Nerve Paralysis, Shoulder Injury, Upper Extremity Injury
Conditions
Brief summary
The goal of this study is the evaluation of erector spinae plane (ESP) blocks as an alternative to interscalene brachial plexus nerve blocks for rotator cuff repair and total shoulder arthroplasty procedures. Currently, single shot interscalene nerve blocks are performed for rotator cuff repair surgeries, and interscalene nerve catheters are placed for total shoulder arthroplasty surgeries. Erector spinae plane blocks are commonly used as part of the anesthetic plan for other surgeries, but less so for shoulder surgeries. The investigators would like to study whether an ESP block can provide similar pain control compared to an interscalene nerve block, with less risk of upper extremity motor block and phrenic nerve block.
Interventions
PROCEDUREInterscalene brachial plexus nerve block
An interscalene brachial plexus nerve block (single shot or catheter, depending on surgical procedure) will be placed under ultrasound guidance and all patients will receive 10cc 0.5% ropivacaine during block placement. Patients with a nerve catheter will receive a bolus of 5cc 0.5% ropivicaine postoperatively, on arrival to the recovery unit.
PROCEDUREErector spinae plane block
An erector spinae plane block (single shot or catheter, depending on surgical procedure) will be placed under ultrasound guidance and all patients will receive 10cc 0.5% ropivacaine during block placement. Patients with a nerve catheter will receive a bolus of 5cc 0.5% ropivicaine postoperatively, on arrival to the recovery unit.
Sponsors
Stanford University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
\- All adult patients (18 years and over) scheduled for rotator cuff surgery or total shoulder arthroplasty surgery requiring a nerve block as part of their anesthetic care
Exclusion criteria
* concomitant life-threatening injuries and other concomitant injuries causing significant pain. * pregnancy, * any condition impairing patient's ability to consent to participation in study * an existing condition contraindicating a nerve block, i.e. nerve injury, existing bleeding disorder * infection in the vicinity of the block, and patient refusal.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of diaphragmatic paresis or paralysis | Before block placement, and 30 minutes after catheter is bolused in recovery | Change in diaphragmatic excursion (measured bilaterally using ultrasonography) from before block placement to 30 minutes after catheter is bolused in recovery |
| Pain score | 48 hours | Pain scores for all patients will be recorded through the first 48 hours postoperatively using the Numeric Rating scale (ranging from 0 to 10, 0 is no pain and 10 is the worst imaginable pain). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Opioid Consumption | 48 hours | Opioid consumption in the recovery room and in the first 48 hours postoperatively will be recorded |
| Adverse effects | 72 hours | Patient-reported adverse effects (dichotomous measure, yes/no): dyspnea, Horner syndrome, hoarseness, difficulty participating in physical therapy due to block |
| Brachial plexus sensory exam change | Before block placement, and 30 minutes after catheter is bolused in recovery | Brachial plexus sensory exam change: dichotomous measurement (yes or no) for change in sensation over C5-C8 dermatomes |
| Incentive spirometry volume change | 24 hours | Change in incentive spirometry volume from baseline (prior to block) to recovery room, and to postoperative day 1. |
| Patient satisfaction | 72 hours | Patient satisfaction with the nerve block (dichotomous measure: yes/no) |
| Brachial plexus motor exam change | Before block placement, and 30 minutes after catheter is bolused in recovery | Brachial plexus motor exam change: dichotomous measurement (yes or no) for change in finger extension, finger abduction and thumb opposition to resistance |
Countries
United States
Outcome results
None listed