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Interscalene brachial plexus block constitutes the analgesic criterion standard for shoulder surgery. However it is associated with a high incidence of hemidiaphragmatic paralysis (HDP) that may not be tolerated by patients with chronic pulmonary disease.
This randomized controlled trial will compare ultrasound-guided interscalene block (ISB) and supraclavicular block in patients undergoing arthroscopic shoulder surgery.
The main outcome is static pain at 30 minutes after arrival in the post anesthesia care unit (PACU) as measured by a numerical rate scale (NRS) from 0 to 10.
Our research hypothesis is that interscalene and supraclavicular blocks will result in equivalent postoperative analgesia at 30 minutes in the PACU. The equivalence margin is set at 2 points
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Interscalene block | Active Comparator | Patients randomized to receive an interscalene block . |
|
| Supraclavicular block | Experimental | Patients randomized to receive a supraclavicular block. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Interscalene block | Procedure | Ultrasound guided brachial plexus block injecting 20 mL of 0.5% levobupivacaine with 5 micrograms of epinephrine per mL in the interscalene groove, under the prevertebral fascia. |
| Measure | Description | Time Frame |
|---|---|---|
| Static pain at 30 minutes after arrival in the PACU | Evaluated with a NRS from 0 to 10. | 30 minutes |
| Measure | Description | Time Frame |
|---|---|---|
| Static pain at 60 minutes after arrival in the PACU | Evaluated with a NRS from 0 to 10. | 60 minutes |
| Postoperative static pain at 2 hours | Evaluated with a NRS from 0 to 10. |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital Clinico Universidad de Chile | Santiago | Metropolitan | 8380456 | Chile |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19282714 | Result | Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJ, Franco CD, Hogan QH. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med. 2009 Mar-Apr;34(2):134-70. doi: 10.1097/AAP.0b013e31819624eb. | |
| 2006740 | Result | Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg. 1991 Apr;72(4):498-503. doi: 10.1213/00000539-199104000-00014. |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D020069 | Shoulder Pain |
| D012133 | Respiratory Paralysis |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| Supraclavicular block | Procedure | Ultrasound guided brachial plexus injecting 20 mL of 0.5% levobupivacaine with 5 micrograms of epinephrine per mL (3 mL in the "corner pocket" followed by 17 mL posterolateral to the brachial plexus). |
|
| 2 hours |
| Postoperative static pain at 3 hours | Evaluated with a NRS from 0 to 10. | 3 hours |
| Postoperative static pain at 6 hours | Evaluated with a NRS from 0 to 10. | 6 hours |
| Postoperative static pain at 12 hours | Evaluated with a NRS from 0 to 10. | 12 hours |
| Postoperative static pain at 24 hours | Evaluated with a NRS from 0 to 10. | 24 hours |
| Incidence of HDP at 30 minutes after interscalene or supraclavicular block | Ultrasound diagnosed HDP | 30 minutes post injection |
| Incidence of HDP at 30 minutes after arrival to PACU. | Ultrasound diagnosed HDP | 30 minutes after arrival to PACU |
| Block performance time | Time from skin desinfection until the end of local anesthetic injection. | 1 hour before surgery |
| Sensory and Motor block | Sensorimotor block assessed every 5 minutes until 30 minutes using a 8-point composite score. | 30 minutes post injection |
| Incidence of complete block | Percentage of blocks with a minimal sensorimotor composite score of 6 points out of a maximum of 8 points at 30 minutes post injection. | 30 minutes post injection |
| Procedural pain during blocks | Evaluated with a NRS from 0 to 10. | 1 hour before surgery |
| Onset time | Time required to reach a minimal sensorimotor composite score of 6 points out of a maximum of 8 points. | 1 hour before surgery |
| Intraoperative opioid requirements | Total amount of fentanyl required during general anesthesia. | Intraoperative period |
| Surgical duration | Time between skin incision and closure. | intraoperative period |
| Postoperative opioid consumption | Total amount of morphine required during the first 24 hours after surgery. | 24 hours after surgery |
| Patient satisfaction | Patient satisfaction measured using a NRS 0 to 10 (0 = unsatisfied; 10 = very satisfied). | 24 hours after surgery |
| Block- and opioid-related side effects | Incidence of side effects. | 1 week |
| 26448030 | Result | Ryu T, Kil BT, Kim JH. Comparison Between Ultrasound-Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Patients Undergoing Arthroscopic Shoulder Surgery: A Prospective, Randomized, Parallel Study. Medicine (Baltimore). 2015 Oct;94(40):e1726. doi: 10.1097/MD.0000000000001726. |
| 27941477 | Result | Tran DQ, Elgueta MF, Aliste J, Finlayson RJ. Diaphragm-Sparing Nerve Blocks for Shoulder Surgery. Reg Anesth Pain Med. 2017 Jan/Feb;42(1):32-38. doi: 10.1097/AAP.0000000000000529. |
| 19916254 | Result | Renes SH, Spoormans HH, Gielen MJ, Rettig HC, van Geffen GJ. Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2009 Nov-Dec;34(6):595-9. doi: 10.1097/aap.0b013e3181bfbd83. |
| 20975470 | Result | Tran DQ, Dugani S, Finlayson RJ. A randomized comparison between ultrasound-guided and landmark-based superficial cervical plexus block. Reg Anesth Pain Med. 2010 Nov-Dec;35(6):539-43. doi: 10.1097/AAP.0b013e3181faa11c. |
| 21568985 | Result | Spence BC, Beach ML, Gallagher JD, Sites BD. Ultrasound-guided interscalene blocks: understanding where to inject the local anaesthetic. Anaesthesia. 2011 Jun;66(6):509-14. doi: 10.1111/j.1365-2044.2011.06712.x. |
| 16331304 | Result | Lloyd T, Tang YM, Benson MD, King S. Diaphragmatic paralysis: the use of M mode ultrasound for diagnosis in adults. Spinal Cord. 2006 Aug;44(8):505-8. doi: 10.1038/sj.sc.3101889. Epub 2005 Dec 6. |
| 29630033 | Derived | Aliste J, Bravo D, Fernandez D, Layera S, Finlayson RJ, Tran DQ. A Randomized Comparison Between Interscalene and Small-Volume Supraclavicular Blocks for Arthroscopic Shoulder Surgery. Reg Anesth Pain Med. 2018 Aug;43(6):590-595. doi: 10.1097/AAP.0000000000000767. |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D018771 | Arthralgia |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D012131 | Respiratory Insufficiency |
| D012120 | Respiration Disorders |
| D012140 | Respiratory Tract Diseases |
| D010243 | Paralysis |
| D009422 | Nervous System Diseases |