Preoperative Ultrasound Guided Thoracic Erector Spinae Plane Block Versus Costoclavicular Block for Shoulder Arthroscopy

Tanta University

Status: Completed

Conditions: Thoracic Erector Spinae Plane Block; Shoulder Arthroscopy; Preoperative; Costoclavicular Block; Ultrasound

Treatments: Drug: Control group; Drug: Costoclavicular block; Drug: Erector Spinae plane Block

Study type: Interventional

Funder types: Other

Identifiers

NCT06913140

35844/9/22

Details and patient eligibility

About

This study was conducted to compare the perioperative analgesic effect of ultrasound guided high thoracic erector spinae plane block versus ultrasound guided costoclavicular block for shoulder arthroscopy

Full description

Shoulder surgery is one of the most common orthopedic surgical procedures that causes severe pain . Pain management in such patients is very important because pain relief allows early mobilization, effective postoperative rehabilitation, and shorter hospitalization stays. Several regional anesthesia techniques have been used for pain management following shoulder surgery. Interscalene brachial plexus block (ISB) is the gold standard analgesic technique for shoulder procedures, but this method can lead to some serious complications, such as hemidiaphragmatic paralysis (HDP), Horner's syndrome, and hoarseness.

The costoclavicular block (CCB) was introduced as infraclavicular approach, first described in 2015 , targets the brachial plexus in the costoclavicular space where its three cords are tightly clustered together lateral to the axillary artery and more superficially than with the classical approach of infraclavicular fossa . Recently, Garcia-Vittoria et al have suggested that the costoclavicular space could also serve as a retrograde channel to supraclavicular brachial plexus blocks, so if local anesthetic (LA) injected in the costoclavicular space can reliably reach the supraclavicular brachial plexus enabling reliable anesthesia including anesthesia to the suprascapular nerve during shoulder surgery, one could achieve analgesic parity with small-volume supraclavicular block (and ISB) while retaining the 0% incidence of HDP seen with infraclavicular blocks.

Erector spinae plane block (ESPB) is a relatively novel block and was first described for chronic thoracic neuropathic pain in 2016 (. It is an interfascial plane block, but it may be classified as a paraspinal block due to its mechanism of action and injection site

Enrollment: 90 patients

Sex: All

Ages: 21 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 90 patients admitted for elective unilateral shoulder arthroscopy.
• Aged (21 - 65) years.
• American Society of Anesthesiologists (ASA) physical activity I, II

Exclusion criteria

• Patient refusal.
• Patient with neurological deficit.
• Patient with bleeding disorders (coagulopathy, thrombocytopenia anticoagulant and antiplatelets drugs).
• Uncooperative patient.
• Infection at the block injection site.
• Patients with history of allergy to local anaesthetics

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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90 participants in 3 patient groups

Erector Spinae plane Block group

Experimental group

Description:

Patients received (20ml) plain bupivacaine 0.25% injected beneath the erector spinae muscle sheath at the level of the second thoracic segment (T2)

Treatment:

Drug: Erector Spinae plane Block

Costoclavicular block group

Experimental group

Description:

Patients received (20ml) plain bupivacaine 0.25% injected in the costoclavicular space lateral to axillary artery

Treatment:

Drug: Costoclavicular block

Control group

Sham Comparator group

Description:

Patients received sham block .

Treatment:

Drug: Control group