Serratus Posterior Superior Intercostal Plane Block Versus Suprascapular Nerve Block and Axillary Nerve Block for Analgesia in Shoulder Arthroscopic Surgery

Tanta University50 enrolled

Overview

This study aims to compare the serratus posterior superior intercostal plane block and suprascapular nerve block and axillary nerve block for analgesia in shoulder arthroscopic surgery.

Controlling postoperative pain while minimizing opioid administration is particularly important because poor pain control is thought to be responsible for more than 60% of unplanned or prolonged hospitalizations. Suprascapular nerve block (SSNB) has been proposed based on the anatomic fact that the suprascapular nerve innervates approximately 70% of the shoulder joint, capsule, subacromial space, acromioclavicular joint, and coracoacromial ligament, with the remaining 30% thought to be innervated by the lateral pectoral and axillary nerve. The combined SSNB and axillary nerve block (ANB) was proposed as a safe alternative to interscalene brachial plexus block (ISB) for providing anesthesia and postoperative analgesia for shoulder surgery. Serratus posterior superior intercostal plane block (SPSIPB) was described as a novel technique in a case series study of cadavers and five patients.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Serratus Posterior Superior Intercostal Plane Block Suprascapular Nerve Block Axillary Nerve Block Analgesia Shoulder Arthroscopic Surgery

Interventions

Serratus posterior superior intercostal plane blockOTHER

Patients will receive a serratus posterior superior intercostal plane block.

Suprascapular nerve block + Axillary nerve blockOTHER

Patients will receive suprascapular nerve block + axillary nerve block.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age from 18 to 65 years. * Both sexes. * American Society of Anesthesiology (ASA) physical status I-II. * Scheduled for open thoracotomy. Exclusion Criteria: * Infection at the site of regional blocks. * Allergy to any drug used in this study. * Use of psychotropic and/or narcotic medications on a regular basis. * Cognitive dysfunction. * Cardiovascular disease. * Pulmonary disease. * Coagulation abnormalities. * Anatomical abnormalities. * Neuropathic pain. * Body mass index \>40. * History of substance abuse. * Previous surgery in the same shoulder.

Locations (1)

Tanta University

Tanta, El-Gharbia, Egypt

Outcomes

Primary Outcomes

Time to the 1st rescue analgesia

Time to the first request for the rescue analgesia (time from end of surgery to first dose of morphine administered).

Time frame: 24 hours postoperatively

Secondary Outcomes

Degree of pain

Each patient will be instructed about postoperative pain assessment with the numeric rating scale (NRS) score. NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). NRS will be assessed at 0, 2, 4, 6, 8, 12, 18, and 24 h postoperatively.

Time frame: 24 hours postoperatively

Intraoperative fentanyl consumption

Additional fentanyl bolus dosages of 1 µg/kg IV will be administered if the heart rate or mean arterial blood pressure is elevated by more than 20% of the baseline.

Time frame: Intraoperatively

Total morphine consumption

Rescue analgesia of morphine will be given as 3 mg bolus if the numeric rating scale (NRS)\> 3 to be repeated after 30 min if pain persists until the NRS \< 4.

Time frame: 24 hours postoperatively

Incidence of adverse events

Incidence of adverse events such as bradycardia, hypotension, nausea, vomiting, respiratory depression, or any other complication.

Time frame: 24 hours postoperatively

Data from ClinicalTrials.gov

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