Diaphragm Protective Block, Interscalene Block, Pain Management, Peripheral Nerve Block, Upper Extremity
Conditions
Keywords
Shoulder Arthroscopy, Interscalene Block, Anterior Suprascapular Block, Axillary Block, Pain Management
Brief summary
Shoulder surgeries are among the most frequently performed orthopedic interventions and are often associated with moderate to severe postoperative pain. In these procedures, effective pain management is crucial for early rehabilitation and patient comfort. Peripheral nerve blockade is widely used for postoperative analgesia in shoulder surgery. While the interscalene brachial plexus block is considered the gold standard for pain control, it is frequently associated with unintended phrenic nerve blockade, leading to hemidiaphragmatic paresis. To minimize respiratory complications while maintaining effective analgesia, alternative diaphragm-sparing regional anesthesia techniques, such as the combination of suprascapular and axillary nerve blocks, have been introduced. The aim of this study is to compare the analgesic efficacy and respiratory functions preservation of the ultrasound-guided anterior approach suprascapular combined with axillary nerve block versus interscalene block in patients undergoing shoulder surgery
Interventions
PROCEDUREInterscalene Block
Interscalene block will be performed on the patients using 10 mL of 0.5% bupivacaine under ultrasound guidance.
PROCEDURECombination of Axillary and Anterior Suprascapular Blocks
Combined anterior suprascapular(5 ml) and axillary nerve blocks(5 ml) will be performed on the patients using a total of 10 mL of 0.5% bupivacaine under ultrasound guidance.
Sponsors
Ankara Etlik City Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Patients aged between 18 and 65 years * American Society of Anesthesiologists (ASA) physical status I, II, or III * Patients scheduled to undergo elective arthroscopic shoulder surgery * BMI between 18 and 30 kg/m2 * Ability to provide written informed consent
Exclusion criteria
* Known allergy or hypersensitivity to local anesthetics * Presence of localized infection at the planned injection site * Severe coagulopathy or active use of anticoagulant medications * Contralateral phrenic nerve palsy or a diagnosis of severe chronic obstructive pulmonary disease (COPD) * History of chronic opioid consumption or neuropathic pain
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Intensity at Rest | 4 hours after surgery. | Pain will be assessed using a visual analog scale from 0 mm (no pain) to 100 mm (worst pain) at rest. Pain assessment at rest will be made at 4 hours after surgery. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Intensity at Rest | Up to 24 hours | Pain will be assessed using a visual analog scale from 0 mm (no pain) to 100 mm (worst pain) at rest. Pain assessment at rest will be made at 1, 8, 12, and 24 hours after surgery. |
| Postoperative Pain Intensity at Movement | Up to 24 hours | Pain will be assessed using a visual analog scale from 0 mm (no pain) to 100 mm (worst pain) at movement. Pain assessment at rest will be made at 1, 4, 8, 12, and 24 hours after surgery. |
| Total Postoperative Opioid Consumption | Up to 24 hours | The total amount of opioid consumed by the patient will be recorded. |
| Area Under Curve | At the 24th hour | Cumulative 24-hour pain burden calculated by the trapezoidal rule |
| Diaphragmatic Excursion | Baseline (immediately before block performance) and 30 minutes after block performance | Diaphragmatic excursion will be measured in centimeters (cm) using M-mode ultrasonography during normal breathing and deep breathing (sniff test). |
| Forced vital capacity (FVC) (volume) | Perioperative period | Forced vital capacity (FVC) (volume) will be evaluated during the perioperative period. Measurements will be performed before block administration (baseline), at 30 minutes after the block, and at postoperative 1 and 24 hours. |
| Forced expiratory flow in 1 s (FEV1) (volume) | Perioperative period | Forced expiratory flow in 1 s (FEV1) (volume) will be evaluated during the perioperative period. Measurements will be performed before block administration (baseline), at 30 minutes after the block, and at postoperative 1 and 24 hours. |
| FEV1/FVC | Perioperative period | FEV1/FVC will be evaluated during the perioperative period. Measurements will be performed before block administration (baseline), at 30 minutes after the block, and at postoperative 1 and 24 hours. |
Countries
Turkey (Türkiye)
Contacts
CONTACTİbrahim Topcu
CONTACTMusa Zengin
Outcome results
None listed