Preoperative, Ultrasound, Thoracic Erector Spinae Plane Block, Costoclavicular Block, Shoulder Arthroscopy
Conditions
Brief summary
This study was conducted to compare the perioperative analgesic effect of ultrasound guided high thoracic erector spinae plane block versus ultrasound guided costoclavicular block for shoulder arthroscopy
Detailed description
Shoulder surgery is one of the most common orthopedic surgical procedures that causes severe pain . Pain management in such patients is very important because pain relief allows early mobilization, effective postoperative rehabilitation, and shorter hospitalization stays. Several regional anesthesia techniques have been used for pain management following shoulder surgery. Interscalene brachial plexus block (ISB) is the gold standard analgesic technique for shoulder procedures, but this method can lead to some serious complications, such as hemidiaphragmatic paralysis (HDP), Horner's syndrome, and hoarseness. The costoclavicular block (CCB) was introduced as infraclavicular approach, first described in 2015 , targets the brachial plexus in the costoclavicular space where its three cords are tightly clustered together lateral to the axillary artery and more superficially than with the classical approach of infraclavicular fossa . Recently, Garcia-Vittoria et al have suggested that the costoclavicular space could also serve as a retrograde channel to supraclavicular brachial plexus blocks, so if local anesthetic (LA) injected in the costoclavicular space can reliably reach the supraclavicular brachial plexus enabling reliable anesthesia including anesthesia to the suprascapular nerve during shoulder surgery, one could achieve analgesic parity with small-volume supraclavicular block (and ISB) while retaining the 0% incidence of HDP seen with infraclavicular blocks. Erector spinae plane block (ESPB) is a relatively novel block and was first described for chronic thoracic neuropathic pain in 2016 (. It is an interfascial plane block, but it may be classified as a paraspinal block due to its mechanism of action and injection site
Interventions
DRUGErector Spinae plane Block
Patients received (20ml) plain bupivacaine 0.25% injected beneath the erector spinae muscle sheath at the level of the second thoracic segment (T2)
Patients received (20ml) plain bupivacaine 0.25% injected in the costoclavicular space lateral to axillary artery.
DRUGControl group
Patients received sham block
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* 90 patients admitted for elective unilateral shoulder arthroscopy. * Aged (21 - 65) years. * American Society of Anesthesiologists (ASA) physical activity I, II
Exclusion criteria
* Patient refusal. * Patient with neurological deficit. * Patient with bleeding disorders (coagulopathy, thrombocytopenia anticoagulant and antiplatelets drugs). * Uncooperative patient. * Infection at the block injection site. * Patients with history of allergy to local anaesthetics
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total Pethidine consumption | 24 hours postoperatively | Each patient was instructed about postoperative pain assessment with the Visual Analogue Scale (VAS). VAS (0 represents no pain while 10 represents the worst pain imaginable) at (T 30 min, 2, 4, 6,12, 18, 24 h, non-steroidal anti-inflammatory drugs were given (ketorolac 30mg) to all patient /8 h and if VAS \> 4 intravenous pethidine 0.5 mg / kg per dose. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to first analgesic request after surgery | 24 hours postoperatively | Time to 1st request for the rescue of analgesia (time from the end of surgery till first dose of morphine administrated) was recorded. |
| Degree of pain | 24 hours postoperatively | Each patient was instructed about postoperative pain assessment with the Visual Analogue Scale (VAS). VAS (0 represents no pain while 10 represents the worst pain imaginable) at (T 30 min, 2, 4, 6,12, 18, 24 h, non-steroidal anti-inflammatory drugs were given (ketorolac 30mg) to all patient /8 h and if VAS \> 4 intravenous pethidine 0.5 mg / kg per dose. |
| Complications | 24 hours postoperatively | Complications (Hematoma, pneumothorax, persistent numbness/ paraesthesia or motor deficit one week after the surgery) were recorded. |
Countries
Egypt
Outcome results
None listed