Preemptive Analgesia
Conditions
Keywords
infraspinatus teres minor block, preemptive analgesia, shoulder surgery
Brief summary
The aim of the study to evaluate the efficacy of the infraspinatus-teres minor (ITM) block in improving pre-emptive analgesia, reducing opioid consumption, and enhancing the overall analgesic effect in patients undergoing shoulder surgeries.
Detailed description
To compare between infraspinatus-teres minor versus control group (GA): 1. To measure analgesic parameters including: the total amount of rescue analgesic consumption (morphine) in the first 24 hours post-operatively in each group, duration of analgesia, and total amount of intraoperative fentanyl consumption and 2. To assess pain score by using numerical rate scale (NRS) at rest (static) and during passive or active movement of shoulder joint (dynamic). 3. To assess discharge time from post anesthesia care unit (PACU). 4. To assess side effects of systemic opioids (constipation, itching, dizziness, nausea and vomiting) and complications of infraspinatus-tere minor block. 5. Patients' satisfaction: The patients will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points Likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia).
Interventions
PROCEDUREInfraspinatus teres minor block group
Patients in this group will receive a unilateral ultrasound-guided Infraspinatus-teres minor (ITM) block with injection of local anesthetics (20 mL of bupivacaine 0.25% (50 mg), 50 mcg dexmedetomidine (0.5 ml) and 8 mg dexamethasone (2 ml)) before induction of general anesthesia
PROCEDUREControl group
Patients in this group will receive general anesthesia
Sponsors
Zagazig University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Anesthetist not sharing in the study will assess outcomes
Intervention model description
To study the efficacy of the infraspinatus-teres minor (ITM) block as pre-emptive analgesia in pain management in patients undergoing shoulder surgeries.
Eligibility
Sex/Gender
ALL
Age
21 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* • Patients' acceptance. * Age: Adults aged 21-65 years old. * BMI: 25-30 kg/m2 * Sex: both sexes (males or females). * Patients undergoing unilateral shoulder surgey under general anesthesia. * ASA (American Society of Anesthesiologists) physical status classification I to II. * Duration of the surgery \< 3hours.
Exclusion criteria
* • Patients with contraindications to regional anesthesia (e.g. local or systemic infections, or severe neurological or muscular or bleeding disorders or patient on anticoagulant). * Allergy to study medications: bupivacaine or dexamethasone, or dexmedetomidine * Patients with severe cardiovascular, respiratory, renal, or hepatic diseases, uncontrolled diabetes , or those undergoing chronic opioid therapy. * Psychiatric disorders that hinder informed consent or study participation. * history of neurological diseases or conditions that would affect the efficacy of nerve blocks (e.g., neuropathy, spinal cord injury, or history of severe muscle weakness). * Patients with nerve injury or disease around the shoulder joint, including thoracic outlet syndrome, Multiple sclerosis, cervical disc disease with ipsilateral radiculopathy, or patients with abnormal sensory or motor function of the upper limb.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| total amount of rescue analgesic consumption | for 24 hours | To assess the total amount of rescue analgesic consumption in the first 24 hours post-operatively in each group. |
| total amount of intraoperative supplementary fentanyl consumption. | up to 3 hours | To measure total amount of intraoperative supplementary fentanyl consumption. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Discharge time from post anesthesia care unit (PACU) | 24 hours | the time from admission to the post-anesthesia care unit (PACU) till discharge from the PACU when the Aldrete score is ≥9). |
| To assess side effects of systemic opioids | for 24 hours | To assess side effects of systemic opioids (constipation, itching, dizziness, nausea & vomiting |
| Numerical Rate Scale (NRS) at rest (static) and during passive or active movement of shoulder (dynamic). | 30 minutes after arrival in the post-anesthesia care unit (PACU), 2 hours, 4 hours, 8 hours, 12 hours, and 24 hours postoperatively. | To assess pain score by using numerical rate scale (NRS) at rest (static) and during passive or active movement of shoulder (dynamic). NRS scale will be explained to all patients as follows: 0= no pain and 10= worst pain. |
| patient's satisfaction | for 24 hours | The patients will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points Likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia) |
| the incidence of block -related side effects or complications | for 24 hours | To assess the incidence of block -related side effects or complications (hematoma, infection or LA toxicity). |
| Time to the first request of rescue analgesia postoperatively | 24 hours postoperative | To assess the time to the first request of rescue analgesia (morphine) postoperatively |
Countries
Egypt
Contacts
Primary ContactDina Elsadek Salem, MD
Outcome results
None listed