Comparison of Postoperative Analgesic Efficacy of SPSIPB and Combination of IBPB and SCPB

Ankara Etlik City Hospital

Status: Enrolling

Conditions: Superficial Cervical Plexus Block; Shoulder Arthroscopy; İnterscalene Brachial Plexus Block; Serratus Posterior Superior Intercostal Plane Block

Treatments: Drug: Interscalene brachial plexus block and superficial cervical plexus block; Drug: Serratus posterior superior intercostal plane block

Study type: Interventional

Funder types: Other

Identifiers

NCT06660875

AEŞH-BADEK-1003-2024

Details and patient eligibility

About

Shoulder arthroscopy is one of the frequently performed surgical procedures today. After shoulder surgery, ensuring sufficent analgesia is necessary for both the patient's comfort and for the early and regular performance of the required postoperative rehabilitation exercises. Nerve blocks provide better pain control, opioid consumption in the postoperative period, and consequently have advantages such as fewer side effects and lower risks of pulmonary and cardiac complications. Multimodal analgesia approach is preferred for patients undergoing shoulder arthroscopy. Along with intravenous analgesic agents, peripheral nerve blocks (applied to every suitable and consenting patient) are performed based on patient preference. This study aims to compare the analgesic efficacy in the postoperative period of patients undergoing shoulder arthroscopy with a combination of interscalene brachial plexus block and superficial cervical plexus block with serratus posterior superior intercostal plane block.

Enrollment: 80 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18 to 65 years old
• American Society of Anesthesiologists (ASA) physical status I-II-III
• Body mass index 18 to 30 kg/m2
• Elective shoulder arthroscopy surgery

Exclusion criteria

• Under 18 and over 65
• ASA score IV and above
• Advanced co-morbidity
• History of bleeding diathesis
• BMI under 18 kg/m2 and over 30 kg/m2
• Patient refusing the procedure
• Patients who have previously undergone shoulder surgery
• Chronic opioid or analgesic use
• Patients who will operate under emergency conditions
• Patients who will not undergo shoulder surgery

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

---

80 participants in 2 patient groups

Serratus posterior superior intercostal plane block

Active Comparator group

Description:

With the patient in the prone position the skin is disinfected .Linear USG probe is placed on the spine of the scapula using an in-plane technique and moved medially. The 3rd rib is identified just on the medial scapular border. After visualizing the trapezius, rhomboid major, and serratus posterior superior muscles (from top to bottom) under USG guidance, a 22-G X 80-mm block needle is directed caudally and advanced until it contacted the rib. To confirm and obtain a plane between the serratus posterior superior and intercostal muscles, hydrodissection is performed using 2 ml of isotonic solution. After the needle site is confirmed, 30 ml of 0.25% bupivacaine is injected ; the local anesthetic spread is confirmed by USG.

Treatment:

Drug: Serratus posterior superior intercostal plane block

Interscalene brachial plexus block and superficial cervical plexus block

Active Comparator group

Description:

İBPB:While the patient is in the supine position, the ultrasound probe is placed on the cricoid cartilage and moved laterally to visualize the trachea, thyroid, carotid artery, internal jugular vein, and sternocleidomastoid muscle. The brachial plexus is identified by directing it posteriorly and laterally between the anterior and middle scalene muscles. After entering between the roots using the in-plane technique and confirming the location with a 2 ml isotonic sodium injection, 20 ml of 0.25% bupivacaine is injected. SCPB:While the patient is in the supine position, the ultrasound probe is placed at the midpoint of the sternocleidomastoid (SCM) muscle. The cervical plexus is visualized deep to the posterior border of the SCM muscle. The needle is inserted deep to the SCM, directed towards the levator scapula. After confirming the location with a 2 ml isotonic sodium injection, 10 ml of 0.25% bupivacaine is injected.

Treatment:

Drug: Interscalene brachial plexus block and superficial cervical plexus block