Shoulder surgeries are among the most frequently performed orthopedic interventions and are often associated with moderate to severe postoperative pain. In these procedures, effective pain management is crucial for early rehabilitation and patient comfort. Peripheral nerve blockade is widely used for postoperative analgesia in shoulder surgery. While the interscalene brachial plexus block is considered the gold standard for pain control, it is frequently associated with unintended phrenic nerve blockade, leading to hemidiaphragmatic paresis. To minimize respiratory complications while maintaining effective analgesia, alternative diaphragm-sparing regional anesthesia techniques, such as the combination of suprascapular and axillary nerve blocks, have been introduced. The aim of this study is to compare the analgesic efficacy and respiratory functions preservation of the ultrasound-guided anterior approach suprascapular combined with axillary nerve block versus interscalene block in patients undergoing shoulder surgery
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
70
Interscalene block will be performed on the patients using 10 mL of 0.5% bupivacaine under ultrasound guidance.
Combined anterior suprascapular(5 ml) and axillary nerve blocks(5 ml) will be performed on the patients using a total of 10 mL of 0.5% bupivacaine under ultrasound guidance.
Ankara Etlik City Hospital
Yenimahalle, Ankara, Turkey (Türkiye)
RECRUITINGPostoperative Pain Intensity at Rest
Pain will be assessed using a visual analog scale from 0 mm (no pain) to 100 mm (worst pain) at rest. Pain assessment at rest will be made at 4 hours after surgery.
Time frame: 4 hours after surgery.
Postoperative Pain Intensity at Rest
Pain will be assessed using a visual analog scale from 0 mm (no pain) to 100 mm (worst pain) at rest. Pain assessment at rest will be made at 1, 8, 12, and 24 hours after surgery.
Time frame: Up to 24 hours
Postoperative Pain Intensity at Movement
Pain will be assessed using a visual analog scale from 0 mm (no pain) to 100 mm (worst pain) at movement. Pain assessment at rest will be made at 1, 4, 8, 12, and 24 hours after surgery.
Time frame: Up to 24 hours
Total Postoperative Opioid Consumption
The total amount of opioid consumed by the patient will be recorded.
Time frame: Up to 24 hours
Area Under Curve
Cumulative 24-hour pain burden calculated by the trapezoidal rule
Time frame: At the 24th hour
Diaphragmatic Excursion
Diaphragmatic excursion will be measured in centimeters (cm) using M-mode ultrasonography during normal breathing and deep breathing (sniff test).
Time frame: Baseline (immediately before block performance) and 30 minutes after block performance
Forced vital capacity (FVC) (volume)
Forced vital capacity (FVC) (volume) will be evaluated during the perioperative period. Measurements will be performed before block administration (baseline), at 30 minutes after the block, and at postoperative 1 and 24 hours.
Time frame: Perioperative period
Forced expiratory flow in 1 s (FEV1) (volume)
Forced expiratory flow in 1 s (FEV1) (volume) will be evaluated during the perioperative period. Measurements will be performed before block administration (baseline), at 30 minutes after the block, and at postoperative 1 and 24 hours.
Time frame: Perioperative period
FEV1/FVC
FEV1/FVC will be evaluated during the perioperative period. Measurements will be performed before block administration (baseline), at 30 minutes after the block, and at postoperative 1 and 24 hours.
Time frame: Perioperative period
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