Shoulder Pain, Phrenic Nerve Paralysis
Conditions
Keywords
bupivacaine, costoclavicular block, upper trunk block
Brief summary
Interscalene brachial plexus block is known as the gold standard for analgesia after shoulder surgery, but limits the use of ipsilateral phrenic nerve paralysis. Recently, interest in potential diaphragm-sparing alternative blocks has increased for patients undergoing shoulder surgery.Two of these blocks are upper trunk block (UTB) and costoclavicular brachial plexus (CCBPB) block. This randomized controlled trial will compare ultrasound-guided UTB and CCBPB in patients undergoing arthroscopic shoulder surgery. The main outcome is pain intensity score at 30 minutes after arrival in the post anesthesia care unit (PACU) as measured by a numerical rating scale (NRS) from 0 to 10. The investigators research hypothesis is that UTB and CCBPB will result in equivalent postoperative analgesia at 30 minutes in the PACU.
Interventions
PROCEDUREUpper trunk block
Block will be applied to supraclavicular zone by 20 ml % 0.25 bupivacaine with 5 mcg/ml epinephrine .
PROCEDURECostoclavicular block
Block will be applied to infraclavicular zone by 20 ml % 0.25 bupivacaine with 5 mcg/ml epinephrine.
PROCEDUREDiaphragmatic function assessment
Diaphragmatic excursion will be assessed under ultrasound immediately before and after regional anesthesia.
PROCEDURECervical plexus blockade
Block will be applied at thyroid cartilage level via 10 ml % 0.25 bupivacaine.
Sponsors
Bezmialem Vakif University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. American Association of Anesthesiologists (ASA) physical status I - III 2. BMI 20 to 35 kg / m2 3. Patients scheduled for elective arthroscopic shoulder surgery
Exclusion criteria
1. Patients who refuse to participate in the study, 2. Pre-existing (obstructive or restrictive) lung disease, 3. Coagulopathy, 4. Sepsis, 5. Hepatic or renal insufficiency, 6. Pregnancy 7. Allergy to local anesthetic drugs, 8. Chronic pain condition requiring opioid intake at home, 9. Surgery in the neck or infraclavicular region 10. BMI above 40. 11. History of psychiatric diseases needing treatment. 12. Failure of nerve block performed in the preoperative block room 13. Substance abuse history
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Detection of diaphragmatic paralysis by ultrasonography | 30 minutes after block application | Ipsilateral diaphragmatic excursion 30 minutes after block completion |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity score | 30 minutes, 1,3, 6, 12, 24 hour after surgery | Postoperative pain assessed with verbal rating scale (VRS 0: no pain 10:pain as bad as can be ) |
| Block perform time | The time from the needle enters the skin until the block is completed | Block application time will be recorded |
| Postoperative opioid consumption | 24 hour after surgery | Total amount of tramadol consumption during the first 24 hours after surgery. Patient controlled analgesia to be inserted. |
| Intraoperative fentanyl requirement | From the beginning to the end of the operation | During the operation, 0.5 μg/kg fentanyl was administered to the patient in case of a 20% increase in the mean blood pressure and heart rate compared to the baseline values |
| Patient satisfaction: NRS | 24 hour after surgery | Patient satisfaction measured using a NRS 0 to 10 (0 = unsatisfied; 10 =very satisfied) |
| Block onset time | Until sensory and motor block occurs | Block onset time will be evaluated and recorded. |
Countries
Turkey (Türkiye)
Contacts
Primary ContactSerdar Yeşiltaş, Instructor
Outcome results
None listed