Analgesia, Axillary Nerve Block, Serratus Posterior Superior Intercostal Plane Block, Shoulder Arthroscopic Surgery, Suprascapular Nerve Block
Conditions
Brief summary
This study aims to compare the serratus posterior superior intercostal plane block and suprascapular nerve block and axillary nerve block for analgesia in shoulder arthroscopic surgery.
Detailed description
Controlling postoperative pain while minimizing opioid administration is particularly important because poor pain control is thought to be responsible for more than 60% of unplanned or prolonged hospitalizations. Suprascapular nerve block (SSNB) has been proposed based on the anatomic fact that the suprascapular nerve innervates approximately 70% of the shoulder joint, capsule, subacromial space, acromioclavicular joint, and coracoacromial ligament, with the remaining 30% thought to be innervated by the lateral pectoral and axillary nerve. The combined SSNB and axillary nerve block (ANB) was proposed as a safe alternative to interscalene brachial plexus block (ISB) for providing anesthesia and postoperative analgesia for shoulder surgery. Serratus posterior superior intercostal plane block (SPSIPB) was described as a novel technique in a case series study of cadavers and five patients.
Interventions
OTHERSerratus posterior superior intercostal plane block
Patients will receive a serratus posterior superior intercostal plane block.
OTHERSuprascapular nerve block + Axillary nerve block
Patients will receive suprascapular nerve block + axillary nerve block.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age from 18 to 65 years. * Both sexes. * American Society of Anesthesiology (ASA) physical status I-II. * Scheduled for open thoracotomy.
Exclusion criteria
* Infection at the site of regional blocks. * Allergy to any drug used in this study. * Use of psychotropic and/or narcotic medications on a regular basis. * Cognitive dysfunction. * Cardiovascular disease. * Pulmonary disease. * Coagulation abnormalities. * Anatomical abnormalities. * Neuropathic pain. * Body mass index \>40. * History of substance abuse. * Previous surgery in the same shoulder.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to the 1st rescue analgesia | 24 hours postoperatively | Time to the first request for the rescue analgesia (time from end of surgery to first dose of morphine administered). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Degree of pain | 24 hours postoperatively | Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS) score. NRS (0 represents no pain while 10 represents the worst pain imaginable). NRS will be assessed at 0, 2, 4, 6, 8, 12, 18, and 24 h postoperatively. |
| Intraoperative fentanyl consumption | Intraoperatively | Additional fentanyl bolus dosages of 1 µg/kg IV will be administered if the heart rate or mean arterial blood pressure is elevated by more than 20% of the baseline. |
| Total morphine consumption | 24 hours postoperatively | Rescue analgesia of morphine will be given as 3 mg bolus if the numeric rating scale (NRS)\> 3 to be repeated after 30 min if pain persists until the NRS \< 4. |
| Incidence of adverse events | 24 hours postoperatively | Incidence of adverse events such as bradycardia, hypotension, nausea, vomiting, respiratory depression, or any other complication. |
Countries
Egypt
Outcome results
None listed