Shoulder Arthroscopic Surgery
Conditions
Keywords
postoperative analgesia, regional anesthesia, shoulder arthroscopy, ultrasonography
Brief summary
The shoulder, being an anatomical region innervated by different nerves, has a wide variety of analgesic approaches, which differ depending on the practitioner. New approaches are being developed based on the different innervation channels demonstrated in clinical and cadaver studies. Over time, the effectiveness of axillary block, suprascapular block, interscalene block, local infiltration, and various combinations, as well as non-regional methods, has been observed. The goal of these approaches is to achieve the highest possible level of patient comfort, high analgesic efficacy, and minimal complications. Studies have shown that the interscalene block has the highest analgesic efficacy and the most ideal postoperative results; therefore, it is frequently used as the gold standard in this field. Providing effective analgesia with a single intervention can also be cited as an aspect that increases patient comfort and simplifies the procedure. In interscalene block; unilateral transient diaphragmatic paralysis due to the spread of local anesthetics to the C7 nerve root, respiratory problems and potential spinal/epidural complications, new approaches are being followed and researched. Results from cervical/high thoracic erector spinae plane block (ESPB) and infraspinatus-teres minor interfascial plane block (ITMIPB) studies, which are the subject of new studies, strengthen the hypothesis that they provide effective analgesia. Neither of these blocks, performed with ultrasonography, carries the risks present in interscalene block. Although the usual risks of a peripheral nerve block are present for these procedures; the block sites are considered safer due to its distance from vascular structures and the reduced risk of additional complications. While small sample studies exist for each type of block, no studies comparing their effectiveness have been found. Besides reduced complications, another advantage of these two blocks is their ability to provide effective analgesia with a single-point injection. The aim of this study is to compare the analgesic efficacy of Cervical Erector Spine Plane Block (ESP) and Infraspinatus-Teres Minor Interfascial Plane Block (ITMIPB) applied for postoperative analgesia in ASA I-III patients undergoing shoulder surgery.
Interventions
PROCEDUREcervical erector spinae plane block
Before shoulder surgery, Ultrasound-guided C8-T1 ESP block will be performed for postoperative analgesia
PROCEDUREInfraspinatus Teres Minor Interfascial Plane Block
Before surgery, Ultrasound-guided Infraspinatus Teres Minor Interfascial Plane Block will be performed for postoperative analgesia
In the both groups, peripheral nerve blocks are performed by using Bupivacaine %0,25.
Sponsors
Taksim Egitim ve Arastirma Hastanesi
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)
Masking description
Our study is a single-blind study. Outcome Assessor will be masked to performed block type.
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Adults scheduled for elective shoulder arthroscopy * ASA I-II-III patients * Patients age between 18-80
Exclusion criteria
* Patients with previously known allergy to local anesthetics. * Patients with insufficient pulmonary functions (Severe obstruction or restriction in Pulmonary Function Test) * Patients with ASA IV or higher * Patients who suffered from any complications related to anesthesia or surgery * Patients with additional body part injury * Pregnant or breastfeeding women
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain intensity | Postoperative 1., 6., 12. and 24. hour | Pain intensity assessed using the 11-point Numeric Rating Scale (NRS; 0=no pain, 10=worst imaginable pain). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total postoperative analgesic consumption | 24 hours after surgery | Total amount of rescue analgesics (NSAIDs, paracetamol, and opioids) administered during the first 24 hours after surgery. Opioid consumption will be converted to intravenous morphine equivalents for analysis, when applicable. |
| Incidence of postoperative nausea and vomiting (PONV) | 24 hours after surgery | Occurrence of postoperative nausea and/or vomiting requiring treatment during the first 24 hours after surgery. Also, the need for rescue antiemetic medication will be recorded. |
| Block-related complications | 24 hours after surgery | Incidence of block-related complications, including local anesthetic systemic toxicity, vascular puncture, hematoma, infection, pneumothorax, persistent sensory or motor deficits, and other procedure-related adverse events. |
Countries
Turkey (Türkiye)
Contacts
CONTACTCanberk Çetinel, MD
Outcome results
None listed