Combined ASSNB and ICBPB vs CCBPB in Shoulder Arthroscopy

Cumhuriyet University

Status: Completed

Conditions: Postoperative Pain; Shoulder Arthroscopy

Treatments: Procedure: Infraclavicular Brachial Plexus Block (ICBPB); Procedure: Anterior suprascapular nerve block (ASSNB); Procedure: Costoclavicular brachial plexus block (CCBPB)

Study type: Interventional

Funder types: Other

Identifiers

NCT06973447

2024-01/08

Details and patient eligibility

About

The aim is to compare the postoperative analgesic and hemidiaphragmatic effects of Anterior SupraScapular Nerve Block (ASSNB) and InfraClavicular Brachial Plexus Block (ICBPB) combination versus CostoClavicular Brachial Plexus Block (CCBPB) in patients undergoing shoulder arthroscopic surgery.

Full description

Patients were divided into two randomized groups: Group 1 (ASSNB+ICBPB Combination group, n=15) and Group 2 (CCBPB group, n=15). All patients will receive the same standard general anesthesia per hospital protocol. All blocks will be applied with the same ultrasonography and block equipment, and by the same physician. Before the anesthesia induction, ipsilateral diaphragmatic excursion will be measured via Ultrasonography (USG). After the anesthesia induction, patients in Group 1 will receive anterior suprascapular nerve block (ASSNB) with 10 mL of 0.25% bupivacaine and infraclavicular brachial plexus block (ICBPB) with 15 mL of 0.25% bupivacaine (with a total volume of 25 mL). Patients in Group 2 will receive costoclavicular brachial plexus block (CCBPB) with 15 mL of 0.25% bupivacaine. All patients will receive Paracetamol 1gr and Dexketoprofen 50mg intravenous (IV) 10 minutes prior to skin closure. After 30 minutes of emergence from anesthesia (upon reaching 9 points on modified Aldrete scoring), ipsilateral diaphragmatic excursion will be assessed again. Pre- and postblock excursion differences will be recorded. Routine analgesic procedure consisting of 3x1gr Paracetamol and 2x50mg Dexketoprofen will be followed postoperatively for 24 hours. Numeric Rating Scale (NRS) will be used to assess postoperative pain on 1st, 6th, 12th, 18th and 24th hours after the surgery. Quality of Recovery-15 Patient Survey will be done both preoperatively for a baseline score, and postoperatively at 24th hour to assess the quality of recovery from the patients' view. Tramadol 50mg IV will be administered as a rescue analgesic for all patients if NRS score is equal to or higher than 4. Total Tramadol consumption will be calculated.

Enrollment: 30 patients

Sex: All

Ages: 18 to 85 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adult patients older than 18 years of age who underwent arthroscopic shoulder surgery under general anesthesia and were American Society of Anesthesiologists (ASA) I-II-III according to the ASA risk classification.

Exclusion criteria

• patients who did not give consent,
• patients with coagulopathy,
• patients with signs of infection at the block application site,
• patients using anticoagulants,
• patients with local anesthetic drug allergies,
• patients with unstable hemodynamics,
• patients who could not cooperate during postoperative pain assessment

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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30 participants in 2 patient groups

Combined ASSNB and ICBPB

Active Comparator group

Description:

For this group, ASSNB and ICBPB blocks will be performed on the ipsilateral side of the patient right after the anesthesia induction with the patients in supine position. For ICBPB, a high frequency linear transducer USG is placed over the lateral infraclavicular fossa in a sagittal orientation medial to the coracoid process and caudal to the clavicle. The block needle is inserted in-plane from a cephalad-to-caudal direction, just inferior to the clavicle to pass through the pectoralis major and minor muscles, aiming toward the posterior aspect of the axillary artery. 15 mL of 0.25% bupivacaine is administered. For ASSNB, the transducer is positioned in a sagittal oblique orientation over the supraclavicular fossa to image the subclavian artery and the brachial plexus. While tracing the plexus craniocaudally, the suprascapular nerve is identified. The needle is advanced in-plane from posterior to anterior. 10 mL of 0.25% bupivacaine is administered.

Treatment:

Procedure: Anterior suprascapular nerve block (ASSNB)

Procedure: Infraclavicular Brachial Plexus Block (ICBPB)

CCBPB

Active Comparator group

Description:

For this group, CCBPC will be performed on the ipsilateral side of the patient right after the anesthesia induction with the patients in supine position. For CCBPB, a high frequency linear transducer of the USG is placed in the medial infraclavicular fossa parallel and next to the clavicle to identify the axillary artery. The transducer is then tilted cephalad to image the brachial plexus and the artery in a perpendicular orientation between the subclavius muscle and the serratus anterior. The needle is advanced in-plane in a lateral-to-medial direction, adjusting the angle to reach the space in between the three cords. 15 mL of 0.25% bupivacaine is administered.

Treatment:

Procedure: Costoclavicular brachial plexus block (CCBPB)