Analgesic Efficacy of US-Guided Interscalene Block Versus Supraclavicular Block for Ambulatory Arthroscopic Rotator Cuff Repair (BISBSC)

Ramsay Générale de Santé

Status: Completed

Conditions: Shoulder Lesions

Treatments: Procedure: arthroscopic shoulder surgery of rotary cuff (CSB); Procedure: arthroscopic shoulder surgery of rotary cuff (ISB)

Study type: Interventional

Funder types: Other

Identifiers

NCT03743974

RGDS BISBSC

Details and patient eligibility

About

Ultrasound-guided interscalene block (ISB) is the reference technique for pain control after ambulatory upper limb surgery, but supraclavicular block (SCB) is an alternative procedure. We compared the efficacy of these two techniques in patients undergoing ambulatory arthroscopic rotator cuff repair (ARCR).

Full description

The number of patients undergoing ambulatory arthroscopic rotator cuff repair (ARCR) in our center is increasing annually. This procedure is associated with significant postoperative pain and effective analgesia is required in order to develop day-case surgery. Although continuous interscalene catheter block (ISB) is considered to be the most effective analgesic technique for ARCR, the difficulties in implementing and monitoring ISB have led to many anesthesiologists preferring single injection block, so that patients can be discharged on the same day as surgery with a satisfactory level of pain control.

ISB is frequently associated with phrenic nerve block,even with low volumes of local anesthetics. Phrenic nerve block is a concern in some ambulatory surgery patients as it may lead to respiratory complications after hospital discharge, limiting the eligibility of many patients for day surgery. Changes in spirometry variables have been associated with ISB, whatever the site of injection around the roots (anterior or posterior). Nevertheless, effective regional anesthesia (RA) is essential for this surgery, because multimodal analgesia alone is insufficient.

Several alternatives to ISB exist that are associated with a decreased prevalence of phrenic nerve paresis.6 Supraclavicular block (SCB) decreases the risk of phrenic nerve involvement, particularly when guided by ultrasound. This technique, which has been linked to a risk of pneumothorax when carried out by neurostimulation only, has now been revived and is included among the RA techniques considered to be safe in terms of respiratory risk, especially when guided by ultrasound. Many studies have demonstrated a decreased risk of phrenic paresis with ultrasound-guided SCB, even with volumes as high as 20 mL. Published studies have demonstrated that SCB is an effective alternative to ISB, and many studies have shown that ultrasound-guided SCB is a safe technique for ambulatory shoulder surgery in terms of respiratory complications. SCB is therefore a real alternative to ISB for ambulatory ARCR, but comparative studies are necessary to evaluate its analgesic efficacy after patients have been discharged from hospital, particularly in terms of their oral morphine consumption at home.

Investigators carried out a monocentric, prospective, comparative study to determine whether SCB is non-inferior to ISB in terms of post-operative analgesia in patients undergoing ambulatory ARCR. Analgesic efficacy was determined by oral morphine use and/or pain scores in patients after hospital discharge. Promotor hypothesis was that SCB would provide similar or better analgesia to ISB in patients returning home on the evening of their surgery.

Enrollment: 108 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• The patients were adults undergoing ARCR by a single surgeon (NJ), under RA and general anesthesia (GA);
• Returning home on the evening of their surgery (hospital stay <12 h);
• Patients adults ;
• Patients with social health insurance ;
• Patient able to understand the objective and constrains of the study.

Exclusion criteria

• patients enable to return home on the evening of their surgery (for a medical or other reason);
• patients taking oral morphine derivatives before their surgery;
• patients with a contraindication for RA or in whom RA was not performed; those with a contraindication for oral morphine derivatives;
• patients who developed a complication during implementation of RA;
• patients refusing to participate in the study;
• patients whose consent was not recorded.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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108 participants in 2 patient groups

Interscalene block

Active Comparator group

Description:

Site of injection for ISB was the C6 plexus nerve root with a posterior in-plane approach, with neurostimulation control, and ultrasound-controlled of extra-plexus injection of the mixture posterior to the C6 root

Treatment:

Procedure: arthroscopic shoulder surgery of rotary cuff (ISB)

Supraclavicular block

Experimental group

Description:

Site of injection for SCB was superficial and lateral to the trunks of the brachial plexus, and not directly deep inside the "corner pocket" zone, with neurostimulation control and visualization of the lung

Treatment:

Procedure: arthroscopic shoulder surgery of rotary cuff (CSB)