Postoperative Acute Pain, Chronic Pain
Conditions
Keywords
shoulder arthroscopy, interscalene block, suprascapular block, brachial plexus
Brief summary
The Importance of Postoperative Analgesia in Shoulder Surgery Shoulder surgery is an orthopedic procedure that can be performed either through open surgery or arthroscopically. Pain following shoulder surgery can lead to adverse outcomes such as decreased functional status, increased consumption of narcotic analgesics, and the development of chronic pain. Therefore, achieving optimal postoperative shoulder analgesia is important not only for patient comfort and satisfaction but also for promoting functional recovery, preventing chronic pain, and reducing the need for narcotic analgesics. Additionally, minimizing the side effects associated with nerve block techniques used for analgesia is crucial for the overall success of the treatment.
Detailed description
The innervation of the shoulder joint is provided by the axillary, musculocutaneous, subscapular, and suprascapular nerves, all of which originate from the brachial plexus. The suprascapular nerve passes through the suprascapular notch on the superior border of the scapula and supplies motor branches to the rotator cuff muscles. Suprascapular nerve block is widely used in the management of shoulder pain. Regional anesthesia techniques are among the most effective methods for postoperative analgesia. Peripheral nerve blocks, a subtype of regional anesthesia, are particularly suitable for postoperative pain control in shoulder surgeries due to their ability to provide long-lasting and effective analgesia, reduce opioid requirements and related side effects or dependency, and facilitate recovery by promoting early functional restoration.Interscalene brachial plexus block (ISB) is commonly used for analgesia in shoulder surgery and is considered the gold standard technique. However, ISB also blocks the phrenic nerve (C3-C5), which may result in ipsilateral hemidiaphragmatic paresis (HDP). This can cause respiratory complications, particularly in patients with preexisting pulmonary disease, obstructive sleep apnea, or morbid obesity. The suprascapular nerve block (SSB), applied at a more distal level of the brachial plexus, preserves the phrenic nerve and thus minimizes the respiratory side effects associated with ISB.
Interventions
OTHERrescue analgesia
In the postoperative recovery room, patients with a Numeric Rating Scale (NRS) score of 4 or higher received 100 mg of intravenous tramadol as rescue analgesia. In addition, both groups routinely received 1 g of intravenous paracetamol every 6 hours during their stay in the ward. During ward follow-up, if the NRS score was 4 or higher, 100 mg of intravenous tramadol was administered as needed.
Sponsors
Aydin Adnan Menderes University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
1. Patients who have provided written informed consent 2. Patients over 18 years of age scheduled for elective shoulder arthroscopy 3. Patients classified as ASA I-II 4. Patients undergoing general anesthesia
Exclusion criteria
1. Patients undergoing shoulder surgery other than arthroscopic procedures (e.g., revision or open surgery) 2. Patients with pre-existing respiratory, cardiac, renal, neurological, or hepatic diseases 3. Presence of neuropathy affecting the brachial plexus 4. Contraindications to peripheral nerve block (e.g., coagulopathy) 5. Known allergy to local anesthetics
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The analgesic efficacy of interscalene block (ISB) and suprascapular block (SSB) will be compared in patients undergoing shoulder arthroscopy. | the first 48 hours postoperatively | It is a pain intensity assessment system based on the patient indicating a point between 0 (no pain) and 10 (unbearable pain) to describe their pain level. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The development of chronic pain following interscalene block (ISB) and suprascapular block (SSB) will be compared in patients undergoing shoulder arthroscopy. | 3 months postoperatively | Postoperative chronic pain will be evaluated after 3 months using a numerical rating pain scale: 0 (no pain) to 10 (unbearable pain). |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORDurali BAYKA
Outcome results
None listed