Postoperative Pain, Shoulder Pain
Conditions
Keywords
SHAC Block
Brief summary
The aim of the study is to compare the post-operative analgesic effect of Shoulder anterior capsule (SHAC) block with Suprascapular nerve block for arthroscopic shoulder surgery with a hypothesis that both Shoulder anterior capsule (SHAC) block and Suprascapular nerve block are effective in providing postoperative analgesia for arthroscopic shoulder surgery.
Detailed description
The role of shoulder arthroscopy in the diagnosis and treatment of shoulder disorders is evolving . Advances in modern arthroscopy have contributed significantly to greater flexibility and efficacy in addressing shoulder pathology.Advantages of arthroscopy include less invasive approaches, improved visualization, decreased risk of many postoperative complications ,and faster recovery. Shoulder surgery is well recognised as having the potential to cause severe postoperative pain.The aim of this review is to assess critically the evidence relating to the effectiveness of regional anaesthesia techniques commonly used for postoperative analgesia following shoulder surgery opioid analgesics are commonly used for analgesia when nerve block are not used. opoids are effective in relieving postoperative pain at rest but may increase postoperative nausea and vomiting (PONV),somnolence,constipation,urinary retention,respiratory depression ,and sleep disturbances. supplementing general anesthesia (GA) with a regional nerve block might improve the quality of postoperative relief pain . Throughout intraoperative and postoperative period, nerve blocks have been used more populary than others because of efficacy.For the regional nerve block,local anesthetic should be infiltrated close to the nerve for maximum effect. Shoulder anterior capsule block (SHAC):is combination of two different blocks .the first block is the interfascial space between the deep layer of the deltoid fascia and the superficial layer of the subscapularis fascia , anterior to the subscapularis myotendinous junction . Thanks to this interfascial space,we can reach both the axillary nerve and the subscapular nerves,the lateral pectoral nerve and the musculocutaneous nerve. Suprascapular nerve block(SSB) :The suprascabular nerve (SSN) originates from the nerve roots and provides sensation for the posterior shoulder capsule, acromioclavicular joint,subacromial bursa,and coracoclavicular ligament .Blocking it provides pre-emptive anesthesia , decreased intraoperative pain ,and postoperative pain relief in shoulder arthroscopy.
Interventions
PROCEDURESHAC block
with the patient in a beach-chair position and with the arm in extension, the subscapularis muscle is stretched posteriorly and becomes easily visible. With external rotation and abduction, the coracobrachialis and the biceps brachii muscles are displaced, allowing the visualization of the interfascial space between the deep lamina of the deltoid muscle fascia and the superficial lamina of the subscapularis fascia.Once the injection into the fascial space is achieved, the investigators can proceed towards the glenohumeral pericapsular space by crossing the subscapularis muscle with the needle. By injecting the pericapsular space, the investigators reach the terminal articular branches indistinctly from their origin. Furthermore, through the Weitbrecht foramen, a natural capsular foramen between the upper and middle glenohumeral ligaments, the investigators also reach the intra-articular space .
PROCEDUREsuprascapular nerve block
Patients will be placed in lateral position by using A high - frequency linear ultrasound probe will be placed approximately 2 cm medial to the medial border of the acromion and about 2 cm cranial to the superior margin of the scapular spine until supraspinatus or infraspinatus muscle contractions were elicited. Following negative aspiration,A 21G 10-cm needle will be inserted using an in-plane approach .The tip of the needle will be placed at the floor of the supraspinatus fossa where the nerve has passed .A volume of 15 mL of a mixture of 2% lidocaine (5 mL) and 0.5% levobupivacaine (10 mL) was injected.
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
For the SHAC block, with the patient in a beach-chair position and with the arm in extension,With external rotation and abduction,A 21G 10-cm needle will be inserted using an in-plane approach .The tip of the needle will be placed at the space where the nerve has passed .A volume of 15 mL of a mixture of 2% lidocaine (5 mL) and 0.5% levobupivacaine (10 mL) was injected By injecting the pericapsular space, we reach the terminal articular branches indistinctly from their origin. For suprascapular nerve block : Patients will be placed in lateral position until supraspinatus or infraspinatus muscle contractions were elicited. Following negative aspiration,A 21G 10-cm needle will be inserted using an in-plane approach .The tip of the needle will be placed at the floor of the supraspinatus fossa where the nerve has passed .A volume of 15 mL of a mixture of 2% lidocaine (5 mL) and 0.5% levobupivacaine (10 mL) was injected.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* -Age between 18-65 years. * Body mass index (BMI)of 18-35Kg /m2. * Patients with American society of anesthesiologist (ASA) physical status \| / \|\|. * Patients scheduled for elective Arthroscopic Shoulder Surgery. * Both sexes, males and females.
Exclusion criteria
* -Patient refusal. * Allergy to local anaesthetics. * Infection at the site of injection . * Coagulopathy. * Chronin pain syndromes. * Prolonged opioid medication .-Patients who received any analgesia 24 h before surgery. * pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| effect on postopeartive pain after shoulder arthrscopy | baseline | the pain intensity assessment at rest and on coughing using Numerical Rating Scale (NRS) This will measure pain intensity from 0 to 10 , 0: no pain 3:mild pain 7:moderate pain 10:severe pain |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| -inceidence of (POVN) 24 hours postoperatively -Block related complications during and after block procedure till 24 hours postoperatively (LAST, pneumohorax and vascular puncture during block procedure) | first 24 hours | patients complaint from occurrence of nausea and vomiting |
| -Time of the first opioid request | first 24 hour | time of the first opioid request , concentration and occurrence of complications (hypotension,bradycardia,itching,urinary retention.) all over 24 hours postoperatively |
| -Block related complications during and after block procedure till 24 hours postoperatively (LAST, pneumohorax and vascular puncture during block procedure) | first 24 hours | occurrence of any complications from technical errors |
Countries
Egypt
Contacts
Primary ContactRana EA Ibrahim, Resident
Backup ContactAyman M Abdel Khalek, Ass professor
Outcome results
None listed