This trial is designed to compare the post-operative analgesic efficacy and safety of liposomal bupivacaine versus plain bupivacaine when both are used for ultrasound-guided combined suprascapular and axillary nerve block in patients undergoing elective arthroscopic shoulder surgery.
Most liposomal bupivacaine data come from ultrasound-guided brachial-plexus blocks; evidence for its safety and efficacy when used specifically for a combined ultrasound-guided suprascapular-plus-axillary block after arthroscopic shoulder surgery is still missing. This trial fills that gap by comparing liposomal bupivacaine with bupivacaine along, aiming to advance multimodal analgesia and enhanced-recovery pathways, cut postoperative pain and stress, and shorten hospital stay.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
60
In the experimental group, 15 mL of a mixture containing liposomal bupivacaine plus plain bupivacaine is deposited around each target nerve (20 mL liposomal bupivacene, 266 mg, combined with 10 mL 0.75 % plain bupivacaine, total 30 mL).
The control group receives 15 mL of 0.25 % plain bupivacaine around each nerve. Unlike the clear solution of plain bupivacaine, liposomal bupivacaine has a distinctive milky-white appearance.
Opioid consumption after surgery
The primary outcome entails tracking and assessing the total opioid consumption by participants following arthroscopic shoulder surgery. The consumption of Opioid via patient-controlled analgesia will be recorded within 72h postoperatively.
Time frame: The outcome will be monitored and recorded within 72 hours postoperatively.
Analgesic efficacy after surgery
To compare the analgesic efficacy of liposomal bupivacaine versus plain bupivacaine when used in ultrasound-guided combined suprascapular and axillary nerve block for arthroscopic shoulder surgery, VAS pain scores will be recorded at several time points from 0 to 72h.
Time frame: The outcome will be monitored and recorded within 72 hours postoperatively
Operative time
Total duration of surgery from skin incision to skin closure, measured in minutes
Time frame: Intraoperative
Length of hospital stay
Duration of hospitalization from admission to discharge, measured in days
Time frame: Through study completion, up to 7 days
Incidence of Allergic Reactions
Mild allergic reactions including skin rash, pruritus, urticaria, or local injection site reactions, graded using CTCAE v5.0 criteria
Time frame: From first dose to 3 days postoperatively
Incidence of Nerve Injury
Nerve injury related to suprascapular and axillary nerve block procedure, assessed by neurological examination including motor function, sensory testing, and presence of paresthesia or dysesthesia in the blocked limb
Time frame: From time of nerve block procedure to 7 days postoperatively
Incidence of Respiratory Depression
Respiratory depression defined as respiratory rate \< 8 breaths per minute, oxygen saturation \< 90%, or need for respiratory support/intervention, assessed by continuous monitoring in PACU
Time frame: within 24 hours postoperatively
Incidence of Local Anesthetic Systemic Toxicity (LAST)
Local anesthetic systemic toxicity events including central nervous system symptoms (confusion, seizures, loss of consciousness) and cardiovascular symptoms (arrhythmias, hypotension, cardiac arrest) assessed using standardized LAST criteria
Time frame: From time of nerve block injection to 6 hours post-procedure
Incidence and Severity of Postoperative Nausea and Vomiting (PONV)
Composite outcome of postoperative nausea and vomiting assessed by patient-reported nausea VAS (0-10) and number of vomiting/retching episodes, categorized as: none (no nausea/vomiting), mild (VAS 1-3 or 1 episode), moderate (VAS 4-6 or 2-3 episodes), severe (VAS ≥ 7 or ≥ 4 episodes or requiring rescue antiemetic)
Time frame: From Post-Anesthesia Care Unit admission to 72 hours postoperatively
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