Interscalene brachial plexus block is known as the gold standard for analgesia after shoulder surgery, but limits the use of ipsilateral phrenic nerve paralysis. Recently, interest in potential diaphragm-sparing alternative blocks has increased for patients undergoing shoulder surgery.Two of these blocks are upper trunk block (UTB) and costoclavicular brachial plexus (CCBPB) block. This randomized controlled trial will compare ultrasound-guided UTB and CCBPB in patients undergoing arthroscopic shoulder surgery. The main outcome is pain intensity score at 30 minutes after arrival in the post anesthesia care unit (PACU) as measured by a numerical rating scale (NRS) from 0 to 10. The investigators research hypothesis is that UTB and CCBPB will result in equivalent postoperative analgesia at 30 minutes in the PACU.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
50
Block will be applied to supraclavicular zone by 20 ml % 0.25 bupivacaine with 5 mcg/ml epinephrine .
Block will be applied to infraclavicular zone by 20 ml % 0.25 bupivacaine with 5 mcg/ml epinephrine.
Diaphragmatic excursion will be assessed under ultrasound immediately before and after regional anesthesia.
Block will be applied at thyroid cartilage level via 10 ml % 0.25 bupivacaine.
Bezmialem Vakıf University
Istanbul, Fatih, Turkey (Türkiye)
RECRUITINGDetection of diaphragmatic paralysis by ultrasonography
Ipsilateral diaphragmatic excursion 30 minutes after block completion
Time frame: 30 minutes after block application
Postoperative opioid consumption
Total amount of tramadol consumption during the first 24 hours after surgery. Patient controlled analgesia to be inserted.
Time frame: 24 hour after surgery
Pain intensity score
Postoperative pain assessed with verbal rating scale (VRS 0: no pain 10:pain as bad as can be )
Time frame: 30 minutes, 1,3, 6, 12, 24 hour after surgery
Block perform time
Block application time will be recorded
Time frame: The time from the needle enters the skin until the block is completed
Block onset time
Block onset time will be evaluated and recorded.
Time frame: Until sensory and motor block occurs
Intraoperative fentanyl requirement
During the operation, 0.5 μg/kg fentanyl was administered to the patient in case of a 20% increase in the mean blood pressure and heart rate compared to the baseline values
Time frame: From the beginning to the end of the operation
Patient satisfaction: NRS
Patient satisfaction measured using a NRS 0 to 10 (0 = unsatisfied; 10 =very satisfied)
Time frame: 24 hour after surgery
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