Postoperative Pain, Acute, Serratus Posterior Superior Intercostal Plane Block, Shoulder Pain
Conditions
Keywords
postoperative analgesia, shoulder arthroscopy, serratus posterior superior intercostal plane block
Brief summary
This study aimed to evaluate the effectiveness of serratus posterior superior intercostal plane (SPSIP) block in managing postoperative pain in patients undergoing arthroscopic shoulder surgery.
Detailed description
Most patients undergoing arthroscopic shoulder surgery report pain in the postoperative period. Pain management remains a significant concern in patient management, as it affects surgical costs, postoperative mobility, length of hospital stay, patient satisfaction, and surgical outcomes. Multimodal analgesia is recommended for the management of postoperative pain. Regional analgesia is an important component of multimodal analgesia. The serratus posterior superior intercostal plane (SPSIP) block is a novel regional analgesia technique described in 2023. SPSIP has been reported to provide near-complete sensory blockade in the posterior neck, shoulder, and hemithorax regions. The main objective of this study is to investigate the effectiveness of SPSIP block in patients undergoing arthroscopic shoulder surgery.
Interventions
PROCEDUREGroup SPSIP: Serratus Posterior Superior İntercostal Plane Block (SPSIP)
Serratus Posterior Superior İntercostal Plane (SPSIP) Block will be performed before the surgery in seated position, under standard sterilization conditions.A linear ultrasound probe will be placed in the sagittal plane along the medial border of the scapula, and the second and third ribs, relevant muscles, and the pleura will be identified. The needle will be advanced into the interfascial plane between the serratus posterior superior and intercostal muscles. After confirmation with salin injection , the block will be performed by injecting 30 mL of 0.25% bupivacaine, and the cranio-caudal spread will be visualized under ultrasound.
Sponsors
Bursa City Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Intervention model description
Active Comparator: Group SPSIP: Participants in this arm will receive an ultrasound-guided serratus posterior superior intercostal plane block before the surgery. Patients will be taken to the operating room after sensory and motor block assessment. Control group: No block procedures will be performed on patients in this arm. Both groups will receive general anesthesia using the standard anesthesia method; induction with lidocaine, propofol, fentanyl, and rocuronium. Maintenance will be provided by inhalation anesthesia and remifentanil infusion. Before the end of surgery, all patients will receive paracetamol, Tramadol, and Tenoxicam intravenously as standard postoperative analgesia. After surgery, patients will be extubated and taken to the post-anesthesia care unit. Patient-controlled analgesia devices will be attached to all patients in the post-anesthesia care unit.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Classified as American Society of Anesthesiologists (ASA) physical status I-II-III * Scheduled for elective shoulder arthroscopy surgery * Surgery performed under general anesthesia * Provision of written informed consent
Exclusion criteria
* Use of anticoagulant or antiplatelet medications * Presence of bleeding diathesis or coagulation disorders * Known allergy or hypersensitivity to local anesthetics or opioid medications * Infection or history of previous surgery at the planned block site * Alcohol or drug dependence * Cognitive impairment preventing reliable pain assessment using the NRS * Pregnancy or lactation * Diabetes mellitus * Renal or hepatic impairment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative 48-Hour PCA Opioid Consumption | Postoperative 0-8, 8-16, 16-24, 24-48 intervals | Total amount of opioid delivered by the patient-controlled analgesia (PCA) device during the first 48 hours after surgery, recorded in milligrams(mg) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| QoR-15 Recovery Score | Postoperative 24th and 48th hours | The investigators will use the Turkish version of Quality of Recovery (QoR) / QoR-15 questionairre PART A How have you been feeling in the last 24 hours? (0 to 10, where: 0 = none of the time \[poor\] and 10 = all of the time \[excellent\]) Able to breathe easily Been able to enjoy food Feeling rested Have had a good sleep Able to look after personal toilet and hygiene unaided Able to communicate with Getting support from hospital doctors and nurses Able to return to work or usual home activities Feeling comfortable and in control Having a feeling of general well-being PART B Have you had any of the following in the last 24 hours? (10 to 0, where: 10 = none of the time \[excellent\] and 0 = all of the time \[poor\]) Moderate pain Severe pain Nausea or vomiting Feeling worried or anxious Feeling sad or depressed |
| Dynamic and static NRS scores | 0, 2, 4, 8, 16, 24, and 48 hours postoperatively | Numeric Rating Scale (NRS) (0-10 0: No pain 10: most pain felt) pain scores at rest or movement at predefined postoperative hours |
| Total rescue analgesic dose | Postoperative 24th and 48th hours | Despite the use of patient-controlled analgesia (PCA), if the Numeric Rating Scale (NRS) score is ≥4 at any time point, 0.5 mg/kg intravenous meperidine will be administered as |
| Time of first request for rescue analgesia, | Postoperative 48-Hours | Despite the use of patient-controlled analgesia (PCA), if the Numeric Rating Scale (NRS) score is ≥4 at any time point, 0.5 mg/kg intravenous meperidine will be administered. The time will be recorded. |
| Length of Hospital Stay | the day of surgery, the day of discharge from the hospital | Number of days spent in hospital after surgery |
| Block and Opioid-Related Adverse Effects and Complications | Postoperative 48-Hours | Block- and opioid-related adverse effects and complications, including but not limited to local anesthetic toxicity, hematoma, infection, nerve injury, nausea, vomiting, pruritus, sedation, and respiratory depression, will be recorded |
| Perioperative Remifentanil infusion dose | Start time: Start of anesthesia administration End time: Termination of anesthesia administration | The amount of remifentanil administered in micrograms during general anesthesia |
Countries
Turkey (Türkiye)
Contacts
CONTACTMursel Ekinci, Assoc prof, MD
CONTACTMerih Yıldız Eglen, MD
PRINCIPAL_INVESTIGATORMerih Yıldız Eglen, MD
Bursa City Hospital
Outcome results
None listed