Regional Anesthesia for Shoulder Surgery
Conditions
Brief summary
Evaluation of shoulder anterior capsule nerve block combined with suprascapular nerve block as an adequate sole anesthetic technique in shoulder arthroscopic surgeries without significant affection of motor power and pulmonary function.
Detailed description
Ultrasonographic peripheral nerve block has been a popular technique not only for pain management but also for surgical anesthesia especially in patients with comorbidities, avoiding complications associated with general anesthesia (airway-difficulties, hemodynamic instability, etc.) and ensuring excellent pain control, reducing peri-operative consumption of opioids and their side effects, and improving patient satisfaction. Interscalene block (ISB) is the gold stander anesthetic technique for shoulder surgeries but hemi-diaphragmatic paralysis still problematic. The SHAC is the combination of two different blocks. The first block is the inter fascial space between the deep layer of the deltoid fascia and the superficial layer of the subscapularis fascia, anterior to the subscapularis myotendinous junction. This inter fascial space, we can reach both the axillary nerve and the subscapular nerves, the lateral pectoral nerve, and the musculocutaneous nerve results in achieving adequate anesthesia and analgesia without phrenic nerve affection. The present study will be conducted to compare of SHAC block combined with suprascapular nerve block and Interscalene block as an anesthetic option in shoulder arthroscopic surgery may allow adequate postoperative analgesia and decrease the overall opioid usage and enhanced patient recovery
Interventions
PROCEDUREShoulder anterior capsule nerve block
Group SHAC block: Patients will receive Ultrasound Guided Shoulder Anterior Capsule block and Suprascapular nerve block
PROCEDUREInterscalene Nerve Block
Group IS block: Patients will receive Ultrasound Guided interscalene brachial plexus block.
Sponsors
Zagazig University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Written informed consent from patients. 2. BMI less than or equal 30 kgm . 3. Age 18-75 years old. 4. ASA class I, II and III.
Exclusion criteria
1. Allergy to local anesthetics. 2. Infection at site of injection. 3. Patients with coagulopathy. 4. Physical and mental disease which could interfere with pain scores evaluation. 5. pre-existing neuropathy of the operative limb. 6. Pre-existing sever pulmonary diseases (obstructive or restrictive). 7. Patients with distorted local anatomy. 8. Patients with chronic pain syndrom \-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Assessment of SHAC block efficacy for postoperative analgesia in shoulder arthroscopic surgeries by using Visual Analogue Scale (VAS) | From start of surgery and for the 1st 24 hours postoperatively. | Inter-operative VAS immediately after the block and every 5 minutes for 30 minutes and every 2 hours post-operatively for 24 hours while 0 indicates no pain and 10 the severest pain. |
| Assessment of SHAC block efficacy for postoperative analgesia in shoulder arthroscopic surgeries by duration of analgesia | 24 hours postoperatively | Assessment of SHAC block efficacy for postoperative analgesia in shoulder arthroscopic surgeries by duration of analgesia. Duration of postoperative analgesia (from the time of patient recovery till the time of rescue analgesia). |
| Assessment of SHAC block efficacy for postoperative analgesia in shoulder arthroscopic surgeries by amount of opioid consumption postoperatively. | 1st 24 hours postoperatively. | Assessment of SHAC block efficacy for postoperative analgesia in shoulder arthroscopic surgeries by amount of opioid consumption postoperatively. Total dose of morphine per mg used during the 1st 24 hours postoperatively. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Safety of SHAC block by monitoring of complications eg. local anesthetic toxicity , hemodynamics instability, phrenic nerve affection, pneumothorax. | From start of surgery and for the 1st 24 hours. | Monitoring of complications like local anesthetic toxicity ( restlessness, irritability, confusion, convulsions and arrhythmias) hemodynamics instability, phrenic nerve affection ( diaphragmatic paralysis) , pneumothorax ( decrease in oxygen saturation monitoring, tachypnea, diminished air entry on affected side by auscultation). |
| Patient satisfaction with the anesthesia and analgesia during and after surgery | From start of surgery and for the 1st 24 hours postoperatively. | Patient satisfaction was evaluated by using satisfaction score and patients were graded on a 5-point scale: 1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, 5 = very satisfied, and assessed at 24 h post-operation |
Countries
Egypt
Outcome results
None listed