Comparison of SPSIPB With SSB and ICB Combination in Arthroscopic Shoulder Surgeries

Cumhuriyet University30 enrolled

Overview

The aim to compare postoperative analgesic requirements between patients undergoing arthroscopic shoulder surgery who received either the SSB-ICB combination or SPSIPB, and to determine whether one technique has superiority over the other.

Patients were divided into two randomized groups: Group 1 (SSB+ICB combination group, n=15) and Group 2 (SPSIPB group, n=15). All patients will receive the same standard general anesthesia per hospital protocol. All blocks will be applied with the same ultrasonography and block equipment, and by the same physician. Before the anesthesia induction, ipsilateral diaphragmatic excursion will be measured via Ultrasonography (USG). After the anesthesia induction, patients in Group 1 will receive anterior suprascapular nerve block (SSB) with 10 mL of 0.25% bupivacaine and infraclavicular brachial plexus block (ICB) with 15 mL of 0.25% bupivacaine (with a total volume of 25 mL). Patients in Group 2 will receive serratus posterior superior intercostal plane block (SPSIPB) with 30 mL of 0.25% bupivacaine. All patients will receive Paracetamol 1gr and Dexketoprofen 50mg intravenous (IV) 10 minutes prior to skin closure. After 30 minutes of emergence from anesthesia (upon reaching 9 points on modified Aldrete scoring), ipsilateral diaphragmatic excursion will be assessed again. Pre- and postblock excursion differences will be recorded. Routine analgesic procedure consisting of 3x1gr Paracetamol and 2x50mg Dexketoprofen will be followed postoperatively for 24 hours. Numeric Rating Scale (NRS) will be used to assess postoperative pain on 1st, 6th, 12th, 18th and 24th hours after the surgery. Quality of Recovery-15 Patient Survey will be done both preoperatively for a baseline score, and postoperatively at 24th hour to assess the quality of recovery from the patients' view. Tramadol 50mg IV will be administered as a rescue analgesic for all patients if NRS score is higher than 4. Total Tramadol consumption will be calculated.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

QUADRUPLE

Enrollment

Conditions

Pain After Shoulder Surgery Shoulder Arthroscopic Surgery

Interventions

suprascapular nerve blockPROCEDURE

Suprascapular nerve block (SSB): 10ml of 0.25% bupivacaine was injected around the suprascapular nerve beneath the omohyoid muscle. Infraclavikular nerve block(ICB): The needle is inserted below the clavicle, directed cephalad-to-caudal through the pectoralis major and minor toward the posterior aspect of the axillary artery, and 15 mL of 0.25% bupivacaine is injected

Serratus posterior superior intercostal plane blockPROCEDURE

Serratus posterior superior intercostal plane block (SPSIPB): 30 ml of 0.25% bupivacaine was injected into the plane between the serratus posterior superior muscle and the ribs.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adult patients older than 18 years of age who underwent arthroscopic shoulder surgery under general anesthesia and were American Society of Anesthesiologists (ASA) I-II-III according to the ASA risk classification. Exclusion Criteria: * patients who did not give consent, * patients with coagulopathy, * patients with signs of infection at the block application site, * patients using anticoagulants, * patients with local anesthetic drug allergies, * patients with unstable hemodynamics, * patients who could not cooperate during postoperative pain assessment * patients diagnosed with frozen shoulder

Locations (1)

Sivas Cumhuriyet University

Sivas, Sivas, Turkey (Türkiye)

Outcomes

Primary Outcomes

Numeric Rating Scale (NRS)

Numeric Rating Scale (NRS): The patient selects a number between 0, representing "no pain," and 10 or 100, representing "unbearable pain." This method is highly sensitive and is one of the most commonly used pain scoring tools.

Time frame: 24 hours after surgery

Total tramadol consumption

Total postoperative analgesic (tramadol) requirement was recorded in the unit as "milligrams".

Time frame: 24 hours after surgery

Secondary Outcomes

Diaphragm Excursion Difference

Ipsilateral diaphragmatic movement will be assessed both immediately before anesthesia induction in the preoperative period and 30 minutes after emergence from anesthesia (when a modified Aldrete score of 9 is reached). A change of up to 25% in diaphragmatic movement indicates no nerve involvement, a change between 25% and 75% indicates partial involvement, and a change exceeding 75% indicates complete phrenic nerve blockade.

Time frame: Preoperatively, immediately before anesthesia induction, and postoperatively, 30 minutes after emergence from anesthesia (when a modified Aldrete score of 9 is reached)

Quality of Recovery-15 Patient Questionnaire (QoR-15)

The widespread use of minimally invasive procedures to reduce postoperative morbidity and mortality, combined with the implementation of Enhanced Recovery After Surgery (ERAS) protocols, has increased overall interest in the postoperative recovery period and the assessment of outcomes. To address emerging needs in this field, new tools prioritizing patient satisfaction have been developed alongside traditional scales that measure classic parameters. Among these, the Quality of Recovery-15 (QoR-15) patient questionnaire stands out as one of the most up-to-date and reliable instruments. The questionnaire is administered both preoperatively, to record the patient's baseline, and 24 hours after surgery. Higher scores indicate better postoperative recovery quality, with possible scores ranging from 0 to 150.

Data from ClinicalTrials.gov

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