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Interscalene brachial plexus block is known as the gold standard for analgesia after shoulder surgery, but limits the use of ipsilateral phrenic nerve paralysis. Recently, interest in potential diaphragm-sparing alternative blocks has increased for patients undergoing shoulder surgery.Two of these blocks are upper trunk block (UTB) and costoclavicular brachial plexus (CCBPB) block. This randomized controlled trial will compare ultrasound-guided UTB and CCBPB in patients undergoing arthroscopic shoulder surgery.
The main outcome is pain intensity score at 30 minutes after arrival in the post anesthesia care unit (PACU) as measured by a numerical rating scale (NRS) from 0 to 10. The investigators research hypothesis is that UTB and CCBPB will result in equivalent postoperative analgesia at 30 minutes in the PACU.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Upper trunk block | Active Comparator | In the supraclavicular region, UTB will be applied with 20 ml % 0.25 bupivacaine with 5 mcg/ml epinephrine. |
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| Costoclavicular brachial plexus block | Active Comparator | In the infraclavicular region, CCBPB will be applied with 20 ml % 0.25 bupivacaine with 5 mcg/ml epinephrine. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Upper trunk block | Procedure | Block will be applied to supraclavicular zone by 20 ml % 0.25 bupivacaine with 5 mcg/ml epinephrine . |
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| Measure | Description | Time Frame |
|---|---|---|
| Detection of diaphragmatic paralysis by ultrasonography | Ipsilateral diaphragmatic excursion 30 minutes after block completion | 30 minutes after block application |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative opioid consumption | Total amount of tramadol consumption during the first 24 hours after surgery. Patient controlled analgesia to be inserted. | 24 hour after surgery |
| Pain intensity score |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Serdar Yeşiltaş, Instructor | Contact | +90 542 363 26 30 | syesiltas@bezmialem.edu.tr |
| Name | Affiliation | Role |
|---|---|---|
| Serdar Yeşiltaş, Instructor | Bezmialem Vakif University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Bezmialem Vakıf University | Recruiting | Istanbul | Fatih | 34093 | Turkey (Türkiye) |
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| ID | Term |
|---|---|
| D020069 | Shoulder Pain |
| ID | Term |
|---|---|
| D018771 | Arthralgia |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D010146 | Pain |
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| ID | Term |
|---|---|
| D066008 | Cervical Plexus Block |
| ID | Term |
|---|---|
| D009407 | Nerve Block |
| D000765 | Anesthesia, Conduction |
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
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| Costoclavicular block | Procedure | Block will be applied to infraclavicular zone by 20 ml % 0.25 bupivacaine with 5 mcg/ml epinephrine. |
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| Diaphragmatic function assessment | Procedure | Diaphragmatic excursion will be assessed under ultrasound immediately before and after regional anesthesia. |
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| Cervical plexus blockade | Procedure | Block will be applied at thyroid cartilage level via 10 ml % 0.25 bupivacaine. |
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Postoperative pain assessed with verbal rating scale (VRS 0: no pain 10:pain as bad as can be )
| 30 minutes, 1,3, 6, 12, 24 hour after surgery |
| Block perform time | Block application time will be recorded | The time from the needle enters the skin until the block is completed |
| Block onset time | Block onset time will be evaluated and recorded. | Until sensory and motor block occurs |
| Intraoperative fentanyl requirement | During the operation, 0.5 μg/kg fentanyl was administered to the patient in case of a 20% increase in the mean blood pressure and heart rate compared to the baseline values | From the beginning to the end of the operation |
| Patient satisfaction: NRS | Patient satisfaction measured using a NRS 0 to 10 (0 = unsatisfied; 10 =very satisfied) | 24 hour after surgery |
| D009461 |
| Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |