This randomized controlled trial aims to compare the effectiveness of interscalene (ISB) and serratus posterior superior intercostal plane block (SPSIP) for postoperative analgesia in patients undergoing elective arthroscopic shoulder surgery. The primary outcome is total 24-hour opioid consumption. Secondary outcomes include pain scores, hemidiaphragmatic paresis incidence and severity, duration of analgesia, and changes in lung function. Participants are randomized into ISB or SPSIP groups; blocks are performed under ultrasound guidance. Postoperative pain is managed with patient controlled analgesia(PCA).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
60
Patients receive ultrasound-guided ISB before arthroscopic shoulder surgery. 15 ml of 0.25% bupivacaine is injected using a 22 Gauge 50 mm needle with posterior in-plane approach, targeting C5-C6 roots.
Patients receive ultrasound-guided SPSIP interfascial block in sitting position before surgery. Using a 22 Gauge 10 mm needle, 30 ml of 0.25% bupivacaine is injected between serratus posterior muscle and second rib.
Erzurum Regional Training Research Hospital
Erzurum, Yakutiye, Turkey (Türkiye)
Total 24-Hour Postoperative Opioid Consumption
Total intravenous opioid consumption recorded for each patient during the first 24 hours after arthroscopic shoulder surgery, including any rescue analgesia administered.
Time frame: 0-24 hours postoperatively
Incidence and Severity of Hemidiaphragmatic Paresis
Ipsilateral hemidiaphragmatic function evaluated by M-mode ultrasonography before block and 30 minutes after block completion. Paresis classified as none (\<25% reduction), partial (25-75% reduction), or complete (\>75% reduction or paradoxical movement).
Time frame: Pre-block and 30 minutes post-block
Duration of Analgesia
0-24 hours post-block
Time frame: Time interval from block completion to initiation of IV PCA fentanyl in each patient
Pulmonary Function Changes (FEV1)
Pulmonary function measured with bedside spirometry pre-block and 30 minutes post-block. Forced expiratory volume in 1 second (FEV1) recorded; each measurement performed three times and mean value used.
Time frame: Pre-block and 30 minutes post-block
Pulmonary Function Changes (FVC)
Pulmonary function measured with bedside spirometry pre-block and 30 minutes post-block. Forced vital capacity (FVC) recorded; each measurement performed three times and mean value used.
Time frame: Pre-block and 30 minutes post-block
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