Efficacy of the C8 Nerve Root Block During Interscalene Block for Anesthesia of the Posterior Aspect of the Shoulder

Daegu Catholic University Medical Center74 enrolled

Overview

This study evaluates the effects of selective 8th cervical nerve root block during interscalene brachial plexus block on the relief of pain intensity upon the introduction of a posterior portal during arthroscopic shoulder surgery. The 5th to 7th cervical nerve roots will be blocked in half of participants, while the 5th to 8th cervical nerve roots will be blocked in the other half.

By blocking only the 5th to 7th cervical nerve blocks, conventional interscalene brachial plexus block spares the 8th cervical and 1st thoracic dermatomes which innervate the posterior aspect of the shoulder. To visualize the shoulder joint space during shoulder arthroscopic surgery, the introduction of a posterior portal is essential. However, conventional interscalene brachial plexus block cannot effectively relieve the pain caused by its insertion due to sparing of the 8th cervical and 1st thoracic dermatomes. The addition of the 8th cervical nerve root block to conventional interscalene brachial plexus block decreases pain intensity upon the introduction of a posterior portal.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

Conditions

Brachial Plexus Block Shoulder Pain

Interventions

Conventional interscalene blockPROCEDURE

Under ultrasound guidance, the 5th to 7th cervical nerve roots are blocked.

Interscalene block with C8 root blockPROCEDURE

Under ultrasound guidance, the 5th to 8th cervical nerve roots are blocked.

0.75% ropivacaineDRUG

Placement of 25 to 30 ml of 0.75% ropivacaine around the cervical nerve roots

Eligibility

Sex: ALLMin age: 20 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * American Society of Anesthesiologists physical status 1 and 2 * Arthroscopic shoulder surgery under interscalene brachial plexus block Exclusion Criteria: * Patient refusal * Contralateral hemidiaphragmatic paralysis or paresis * Contralateral vocal cord palsy * Severe pulmonary restrictive disease * Coagulopathy * Allergy to local anesthetics or history of allergic shock * Difficulty communicating with medical personnel * Peripheral neuropathy or neurologic sequelae on the operative limb

Locations (1)

Daegu Catholic University Medical Center

Daegu, South Korea

Outcomes

Primary Outcomes

Pain intensity upon the introduction of a posterior portal

0, 1, and 2 represent no pain, mild pain, and severe pain, respectively.

Time frame: 50 minutes after interscalene block

Secondary Outcomes

Sensory blockade

C5 to T1 dermatomal blockade graded from 0 to 2 (0 = no cold sensation, 1 = reduced cold sensation, and 2 = normal cold sensation) by applying ice to the shoulder

Time frame: 30 minutes after interscalene block

Motor blockade

Motor blockade of the radial, ulnar, median, musculocutaneous, and axillary nerves graded from 0 to 2 (0 = complete block, 1 = partial block, and 2 = no block)

Time frame: 30 minutes after interscalene block

Ipsilateral hemidiaphragmatic blockade

Extent of a reduction in the amplitude of excursion of the diaphragm on the vertical axis of the M-mode wave under M-mode ultrasound evaluation

Time frame: Before interscalene block and 30 minutes after interscalene block

Horner's syndrome

The extent of a reduction in the ipsilateral pupil size measured by a pupillometer Presence or absence of ptosis

Time frame: Before interscalene block and 30 minutes after interscalene block

Pulmonary function test

Forced expiratory volume at one second (FEV1) and FEV1/forced vital capacity before and 30 minutes after the end of local anesthetic injection

Time frame: Before interscalene block and 30 minutes after interscalene block

Complications related with interscalene block

Data from ClinicalTrials.gov

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