Analgesia, Anterior Glenoid Nerve Block, Arthroscopic Shoulder Surgery, Diaphragmatic Excursion, Interscalene Block, Suprascapular Nerve Block
Conditions
Brief summary
This study aims to evaluate the diaphragmatic movement and postoperative analgesia following anterior glenoid, suprascapular, and interscalene nerve blocks in patients undergoing elective arthroscopic shoulder surgery.
Detailed description
Arthroscopic shoulder surgery is a key approach for diagnosing and treating many shoulder disorders. Nevertheless, 30-70% of patients often experience moderate to severe pain, especially at 48 h after the operation, which affects rapid recovery. The interscalene brachial plexus block (ISB) remains the gold standard for providing analgesia after shoulder surgery. Suprascapular nerve block (SSNB) is the most commonly used regional nerve block. Seventy percent of the sensory nerve fibers of the shoulder joint are innervated by the suprascapular nerve (SSN), with the supraspinatus and infraspinatus being directly innervated by the SSN.
Interventions
OTHERInterscalene brachial plexus block
Patients will receive general anesthesia, plus an ultrasound-guided interscalene brachial plexus block (ISB) with the injection of 15 mL of 0.25% bupivacaine.
OTHERSuprascapular nerve block
Patients will receive general anesthesia plus an ultrasound-guided suprascapular nerve block (SSNB) with injection of 15 ml of 0.25% bupivacaine.
OTHERAnterior glenoid block
Patients will receive general anesthesia plus an ultrasound-guided anterior glenoid block with injection of 15 ml of 0.25% bupivacaine.
OTHERSuprascapular nerve block + Anterior glenoid block
Patients will receive general anesthesia, along with a total volume of 30 mL of 0.25% bupivacaine, divided into 15 mL for ultrasound-guided SSNB and 15 mL for ultrasound-guided anterior glenoid 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
* Age from 21 to 65 years. * Both sexes. * American Society of Anesthesiologists (ASA) physical status I or II. * Scheduled for arthroscopic shoulder surgery.
Exclusion criteria
* Patient's refusal to participate. * Patients with a history of allergy to local anesthetics. * Patients with a history of chronic use of painkillers. * Patients presented with mental dysfunction. * Patients with coagulation disorders. * Patients presented with skin or soft tissue infection at the proposed site of needle Insertion. * Pregnant Patients. * Patients with Chronic Obstructive Pulmonary Disease (COPD) or a Body Mass Index (BMI) of more than 40.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of hemi-diaphragmatic paralysis | 24 hours postoperatively | Incidence of hemi-diaphragmatic paralysis determined by ultrasound-guided assessment of diaphragmatic excursion. Diaphragmatic excursion will be measured before procedure (pre-block), 30 minutes after performing the block and post operative after complete recovery in post-anesthesia care unit (PACU). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Degree of pain | 24 hours postoperatively | Each patient will be instructed about postoperative pain assessment with the numerical rating scale (NRS) score. NRS (0 represents no pain while 10 represents the worst pain imaginable). NRS will be recorded at T0, 30 min, 2, 4, 6, 12, 18, and 24 hours postoperatively. |
| Total analgesic consumption | 24 hours postoperatively | All patients will receive Paracetamol 1 g/6 hours as a regular analgesia and Morphine 3mg if the numerical rating scale (NRS) \> 3 as a rescue analgesia. |
| Degree of patient satisfaction | 24 hours postoperatively | The degree of patient satisfaction will be assessed based on a questionnaire and graded on a 4-point scale (excellent/good/fair/poor) |
Countries
Egypt
Contacts
Primary ContactFatma E Elsamahy, Master
Outcome results
None listed