The aim of the study to evaluate the efficacy of the infraspinatus-teres minor (ITM) block in improving pre-emptive analgesia, reducing opioid consumption, and enhancing the overall analgesic effect in patients undergoing shoulder surgeries.
To compare between infraspinatus-teres minor versus control group (GA): 1. To measure analgesic parameters including: the total amount of rescue analgesic consumption (morphine) in the first 24 hours post-operatively in each group, duration of analgesia, and total amount of intraoperative fentanyl consumption and 2. To assess pain score by using numerical rate scale (NRS) at rest (static) and during passive or active movement of shoulder joint (dynamic). 3. To assess discharge time from post anesthesia care unit (PACU). 4. To assess side effects of systemic opioids (constipation, itching, dizziness, nausea and vomiting) and complications of infraspinatus-tere minor block. 5. Patients' satisfaction: The patients will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points Likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
60
Patients in this group will receive a unilateral ultrasound-guided Infraspinatus-teres minor (ITM) block with injection of local anesthetics (20 mL of bupivacaine 0.25% (50 mg), 50 mcg dexmedetomidine (0.5 ml) and 8 mg dexamethasone (2 ml)) before induction of general anesthesia
Patients in this group will receive general anesthesia
Faculity of medicine, Zagazig university, Zagazig
Zagazig, Egypt, Egypt
RECRUITINGFaculty of human medicine, Zagazig university, Zagazig
Zagazig, Egypt
RECRUITINGtotal amount of rescue analgesic consumption
To assess the total amount of rescue analgesic consumption in the first 24 hours post-operatively in each group.
Time frame: for 24 hours
total amount of intraoperative supplementary fentanyl consumption.
To measure total amount of intraoperative supplementary fentanyl consumption.
Time frame: up to 3 hours
Numerical Rate Scale (NRS) at rest (static) and during passive or active movement of shoulder (dynamic).
To assess pain score by using numerical rate scale (NRS) at rest (static) and during passive or active movement of shoulder (dynamic). NRS scale will be explained to all patients as follows: 0= no pain and 10= worst pain.
Time frame: 30 minutes after arrival in the post-anesthesia care unit (PACU), 2 hours, 4 hours, 8 hours, 12 hours, and 24 hours postoperatively.
Time to the first request of rescue analgesia postoperatively
To assess the time to the first request of rescue analgesia (morphine) postoperatively
Time frame: 24 hours postoperative
Discharge time from post anesthesia care unit (PACU)
the time from admission to the post-anesthesia care unit (PACU) till discharge from the PACU when the Aldrete score is ≥9).
Time frame: 24 hours
To assess side effects of systemic opioids
To assess side effects of systemic opioids (constipation, itching, dizziness, nausea \& vomiting
Time frame: for 24 hours
the incidence of block -related side effects or complications
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To assess the incidence of block -related side effects or complications (hematoma, infection or LA toxicity).
Time frame: for 24 hours
patient's satisfaction
The patients will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points Likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia)
Time frame: for 24 hours