Interscalene Blocks, Rotator Cuff Tear Repair, Rotator Cuff Tears
Conditions
Keywords
Rotator Cuff Tears, Arthroscopic Rotator Cuff Repair, Interscalene Nerve Block, Regional Anesthesia, Postoperative Pain, Preemptive Analgesia, Pain Management
Brief summary
This study is evaluating whether the timing of an interscalene nerve block affects pain control and recovery after arthroscopic rotator cuff repair surgery. An interscalene block is commonly used to reduce pain after shoulder surgery. However, it is not known whether administering the block before surgery or after surgery provides better outcomes. Participants undergoing arthroscopic rotator cuff repair are assigned to receive the interscalene block either before the surgical incision or after completion of the procedure. The study compares postoperative pain levels, opioid medication use, length of hospital stay, and ultrasound imaging quality during block administration between the two groups. Functional recovery is also assessed using patient-reported outcome measures during follow-up. The investigators hypothesize that administration of the interscalene block before surgery may provide superior early pain control and reduce postoperative opioid requirements while maintaining similar functional outcomes compared with administration after surgery.
Detailed description
Postoperative pain remains a major challenge following arthroscopic rotator cuff repair despite advances in multimodal analgesia protocols. Inadequate pain control may delay rehabilitation, increase opioid consumption, prolong hospitalization, and negatively affect patient satisfaction. Ultrasound-guided interscalene block has become a cornerstone of perioperative pain management for shoulder surgery because of its proven analgesic efficacy and favorable safety profile. Although interscalene block is routinely used in clinical practice, the optimal timing of administration remains controversial. Administration before surgical incision may provide preemptive analgesic effects by attenuating central sensitization and reducing nociceptive input during surgery. In contrast, administration after completion of surgery has been proposed as a strategy to extend the duration of postoperative analgesia. Existing literature provides limited and inconsistent evidence regarding the comparative clinical benefits of these approaches in patients undergoing arthroscopic rotator cuff repair. This study was designed to evaluate the impact of interscalene block timing within a contemporary shoulder surgery pathway. In addition to its potential influence on perioperative analgesia, the timing of block administration may affect procedural workflow and ultrasound visualization of relevant anatomical structures. Improved understanding of these factors may contribute to optimization of perioperative management strategies and support evidence-based recommendations for regional anesthesia practices in arthroscopic shoulder surgery.
Interventions
None listed
Sponsors
Istinye University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 years or older. * Patients undergoing primary arthroscopic rotator cuff repair. * Presence of a repairable small-, medium-, or large-sized rotator cuff tear confirmed by clinical and imaging evaluation. * Receipt of an ultrasound-guided interscalene nerve block as part of perioperative pain management. * Ability to provide informed consent and comply with study follow-up requirements.
Exclusion criteria
* Irreparable rotator cuff tears. * Partial-thickness rotator cuff tears not requiring repair. * Revision rotator cuff repair procedures. * Concomitant shoulder procedures that could substantially influence postoperative pain or functional outcomes (e.g., shoulder arthroplasty, fracture fixation). * Previous surgery on the affected shoulder. * Contraindications to interscalene nerve block, including local anesthetic allergy, infection at the injection site, or severe neurologic disease affecting the brachial plexus. * Chronic opioid use or opioid dependence before surgery. * Inability to complete study questionnaires or follow the postoperative rehabilitation protocol. * Missing baseline or follow-up data required for outcome assessment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Early Postoperative Pain Intensity | Pre-procedure, postoperative 6th, 12th, 24th hours | Patients' postoperative pain intensity measured using the Visual Analog Scale (VAS) following arthroscopic rotator cuff repair. Pain scores will be compared between pre-procedure and post-procedure interscalene block groups. The scale ranges from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate worse pain intensity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Opioid Consumption | 24 hours after surgery | Total opioid consumption recorded during the first postoperative 24 hours. |
| Patient-Controlled Analgesia Usage | 24 hours after surgery | Number of patient-controlled analgesia (PCA) bolus demands during the postoperative period. |
| Duration of hospitalization following arthroscopic rotator cuff repair. | From surgery until hospital discharge | Duration of hospitalization following arthroscopic rotator cuff repair. |
| Ultrasound Image Quality During Interscalene Block Administration | At the time of interscalene block administration | Quality of ultrasound visualization of the interscalene region assessed by the performing anesthesiologist using a 5-point Likert scale. |
| Oxford Shoulder Score | Baseline, 3 months, and 6 months after surgery | Functional shoulder outcome assessed using the Oxford Shoulder Score questionnaire. The Oxford Shoulder Score ranges from 0 to 48, with higher scores indicating better shoulder function. |
| Disabilities of the Arm, Shoulder and Hand (DASH) Score | Baseline, 3 months, and 6 months after surgery | Upper extremity functional outcome assessed using the DASH questionnaire. The score ranges from 0 to 100, with higher scores indicating greater disability and worse upper extremity function. |
Countries
Turkey (Türkiye)
Contacts
CONTACTKaya Turan, MD, FEBOT, Assoc Prof.
STUDY_CHAIRAli S. Kavaklı, Professor
Istinye University
PRINCIPAL_INVESTIGATOROnur Senyurt, MD
Istinye University
STUDY_DIRECTORKaya Turan, MD, Assoc Prof
Istinye University
PRINCIPAL_INVESTIGATORTaylan Sahin, MD
Istinye University
Outcome results
None listed