Shoulder Pain
Conditions
Keywords
Postoperative pain, Analgesia, Regional Anesthesia, Interscalene brachial plexus block, Serratus posterior superior plane block
Brief summary
This randomized controlled trial aims to compare the effectiveness of interscalene (ISB) and serratus posterior superior intercostal plane block (SPSIP) 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 SPSIP groups; blocks are performed under ultrasound guidance. Postoperative pain is managed with patient controlled analgesia(PCA).
Interventions
Patients receive ultrasound-guided ISB before arthroscopic shoulder surgery. 15 ml of 0.25% bupivacaine is injected using a 22 Gauge 50 mm needle with posterior in-plane approach, targeting C5-C6 roots.
PROCEDURESerratus Posterior Superior Intercostal Plane Block (SPSIP)
Patients receive ultrasound-guided SPSIP interfascial block in sitting position before surgery. Using a 22 Gauge 10 mm needle, 30 ml of 0.25% bupivacaine is injected between serratus posterior muscle and second rib.
Sponsors
Erzurum Regional Training & Research Hospital
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
* Agreeing to participate in the study * The American Society of Anesthesiologists I-III * Scheduled for elective unilateral arthroscopic shoulder surgery
Exclusion criteria
* Refusal to participate in the study * Allergy to the medications to be used * History of serious heart, kidney or liver disease * Neurological deficits or neuropathy * History of anticoagulant use * Pre-existing operative respiratory dysfunction * Having chronic shoulder pain * Being about to undergo 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 | Time interval from block completion to initiation of IV PCA fentanyl in each patient | 0-24 hours post-block |
| 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)
Outcome results
None listed