Arthroscopic Shoulder Surgery
Conditions
Keywords
Postoperative Pain, Analgesia, Regional Anesthesia, Interscalene Brachial Plexus Block, Infraspinatus-Teres Minor Block
Brief summary
This randomized controlled trial aims to compare the effectiveness of interscalene (ISB) and infraspinatus-teres minor (ITM) blocks for postoperative analgesia in patients undergoing elective arthroscopic shoulder surgery. The primary outcome is total 24-hour opioid consumption. Secondary outcomes include pain scores, hemidiaphragmatic paresis incidence and severity, duration of analgesia, and changes in lung function. Participants are randomized into ISB or ITM groups; blocks are performed under ultrasound guidance. Postoperative pain is managed with patient controlled analgesia(PCA).
Detailed description
This is a single-center, prospective, randomized clinical trial designed to compare the efficacy of Interscalene Brachial Plexus Block (ISB) and Infraspinatus-Teres Minor (ITM) interfascial block in patients undergoing elective unilateral arthroscopic shoulder surgery. The primary objective is to compare total 24-hour postoperative opioid consumption. Secondary objectives include the and pain scores, incidence and severity of hemidiaphragmatic paresis, duration of analgesia (from block completion to initiation of IV PCA), and postoperative pulmonary function changes. This study aims to determine whether the ITM block provides comparable perioperative analgesia to the ISB block while potentially reducing hemidiaphragmatic paresis and pulmonary compromise.
Interventions
Patients receive ultrasound-guided ISB before arthroscopic shoulder surgery. After sedation with IV midazolam, 15 ml of 0.25% bupivacaine is injected using a 22 Gauge 50 mm needle with posterior in-plane approach, targeting C5-C6 roots.
PROCEDUREInfraspinatus-Teres Minor Block (ITM)
Patients receive ultrasound-guided ITM interfascial block in sitting position before surgery. Using a 22 Gauge 10 mm needle, 25 ml of 0.25% bupivacaine is injected between infraspinatus and teres minor muscles via out-of-plane or in-plane hydrodissection.
Sponsors
Ataturk University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
The anesthesiologist performing the blocks is aware of the group allocation; all other staff and outcome assessors are blinded.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* The American Society of Anesthesiologists I-III * Scheduled for elective unilateral arthroscopic shoulder surgery * Provide written informed consent
Exclusion criteria
* Refusal to participate * Allergy to study drugs * Severe cardiac, renal, or hepatic disease * Neurological deficit or neuropathy * Anticoagulant therapy * Pre-existing respiratory dysfunction * Chronic shoulder pain or planned open surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total 24-Hour Postoperative Opioid Consumption | 0-24 hours postoperatively | Total intravenous opioid consumption recorded for each patient during the first 24 hours after arthroscopic shoulder surgery, including any rescue analgesia administered. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence and Severity of Hemidiaphragmatic Paresis | Pre-block and 30 minutes post-block | Ipsilateral hemidiaphragmatic function evaluated by M-mode ultrasonography before block and 30 minutes after block completion. Paresis classified as none (\<25% reduction), partial (25-75% reduction), or complete (\>75% reduction or paradoxical movement). |
| Duration of Analgesia | 0-24 hours post-block | Time interval from block completion to initiation of IV PCA fentanyl in each patient. |
| Pulmonary Function Changes (FEV1) | Pre-block and 30 minutes post-block | Pulmonary function measured with bedside spirometry pre-block and 30 minutes post-block. Forced expiratory volume in 1 second (FEV1) recorded; each measurement performed three times and mean value used. |
| Pulmonary Function Changes (FVC) | Pre-block and 30 minutes post-block | Pulmonary function measured with bedside spirometry pre-block and 30 minutes post-block. Forced vital capacity (FVC) recorded; each measurement performed three times and mean value used. |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORAli Ahıskalıoğlu, Professor
Ataturk University Department of Anesthesiology and Reanimation
Outcome results
None listed