Postoperative Pain, Shoulder Arthoscopy
Conditions
Keywords
postoperative pain, shoulder arthroscopy, regional anesthesia, costoclavicular brachial plexus block, serratus posterior superior intercostal plane block
Brief summary
The aim is to compare the postoperative analgesic and hemidiaphragmatic effects of Serratus Posterior Superior Intercostal Plane Block (SPSIPB) versus CostoClavicular Brachial Plexus Block (CCBPB) in patients undergoing arthroscopic shoulder surgery.
Detailed description
Patients were divided into two randomized groups: Group 1 (SPSIPB group, n=15) and Group 2 (CCBPB group, n=15). All patients will receive the same standard general anesthesia per hospital protocol. All blocks will be applied with the same ultrasonography and block equipment, and by the same physician. Before the anesthesia induction, ipsilateral diaphragmatic excursion will be measured via Ultrasonography (USG). After the anesthesia induction, patients in Group 1 will receive Serratus Posterior Superior Intercostal Plane Block (SPSIPB) with 30 mL of 0.25% bupivacaine. Patients in Group 2 will receive Costoclavicular Brachial Plexus Block (CCBPB) with 15 mL of 0.25% bupivacaine. All patients will receive Paracetamol 1gr and Dexketoprofen 50mg intravenous (IV) 10 minutes prior to skin closure. After 30 minutes of emergence from anesthesia (upon reaching 9 points on modified Aldrete scoring), ipsilateral diaphragmatic excursion will be assessed again. Pre- and postblock excursion differences will be recorded. Routine analgesic procedure consisting of 3x1gr Paracetamol IV and 2x50mg Dexketoprofen IV will be followed postoperatively for 24 hours. Numeric Rating Scale (NRS) will be used to assess postoperative pain on 1st, 6th, 12th, 18th and 24th hours after the surgery. Quality of Recovery-15 Patient Survey will be done both preoperatively for a baseline score, and postoperatively at 24th hour to assess the quality of recovery from the patients' view. Tramadol 50mg IV will be administered as a rescue analgesic for all patients if NRS score is equal to or higher than 4. Total Tramadol consumption will be calculated.
Interventions
PROCEDURESerratus posterior superior intercostal plane block
30 mL of 0.25% bupivacaine
15 mL of 0.25% bupivacaine
Sponsors
Cumhuriyet University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Adult patients older than 18 years of age who underwent unilateral elective arthroscopic shoulder surgery under general anesthesia and were American Society of Anesthesiologists (ASA) score I-II-III according to the ASA risk classification.
Exclusion criteria
* patients who did not give consent, * patients with coagulopathy, * patients with signs of infection at the block application site, * patients using anticoagulants, * patients with local anesthetic drug allergies, * patients with unstable hemodynamics, * patients who could not cooperate during postoperative pain assessment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Numeric Rating Scale (NRS) Scores | Postoperative 24 hours | Numerical rating scale is used for pain assessment. The scores of the numerical rating scale changes between 0 to 10 points. 10 points mean "the most severe pain that the patient ever had". 0 point means "there is no pain." Higher scores mean worse outcome. |
| Diaphragmatic Excursion Difference | Preoperatively right before the anesthesia induction, and postoperatively after 30 minutes of emergence from anesthesia (upon reaching 9 points on modified Aldrete scoring) | Ipsilateral diaphragmatic excursions will be measured both preoperatively right before the anesthesia induction, and postoperatively after 30 minutes of emergence from anesthesia (upon reaching 9 points on modified Aldrete scoring). A diaphragmatic excursion change of up to 25% indicates no nerve involvement, a change between 25%-75% indicates partial involvement, and a change exceeding 75% indicates complete involvement of the phrenic nerve. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total tramadol consumption | Postoperative 24 hours | Postoperative total opioid need was recorded as "milligram" in unit. |
| Quality of Recovery-15 Patient Survey (QoR-15) | Preoperatively and Postoperatively at 24th hour | The widespread use of minimally invasive interventions to reduce postoperative mortality and morbidity, combined with the implementation of Enhanced Recovery After Surgery (ERAS) protocols, has heightened overall interest in the postoperative recovery period and the importance of outcome evaluation. To address the emerging needs in this field, new tools prioritizing patient satisfaction have been developed alongside traditional scales that measure classical parameters. The Quality of Recovery-15 Patient Survey (QoR-15) stands out as one of the most up-to-date and reliable examples among these tools. The survey is done both preoperatively to record patients' baseline score, and postoperatively at 24th hour. Higher scores mean better quality of recovery after surgery. Mininum and maximum scores can be '0 (zero)' and '150 (one hundred and fifty)' respectively. |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATOROğuz Gündoğdu
Sivas Cumhuriyet University School of Medicine, Anesthesiology and Reanimation
Outcome results
None listed