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This study evaluates the analgesia induced by suprascapular nerve block in comparison to interscalene nerve block in arthroscopic rotator cuff repairs. The experimental and the control group will receive the suprascapular nerve block and interscalene nerve block, respectively.
Peripheral nerve blocks are widely used for postsurgical analgesia. Interscalene nerve block provides a total brachial plexus motor and sensitive blockade while the suprascapular nerve block produces only a specific peripheral blockade.
The interscalene nerve block is the most frequently used anesthesia technique and requires a longer learning curve. Complications related to this technique may be more severe and frequent in comparison to other regional anesthesia techniques.
The suprascapular nerve block yields less adverse effects, discomfort and rebound effect as this technique does not completely block the upper limb motor function.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Suprascapular nerve block (SSNB) | Experimental | Single shot using the blind block technique with 10 ml 0.75% ropivacaine and arthroscopic portals infiltration with 5 ml 0.75% diluted in 15 ml of distilled water. |
|
| Interscalene Nerve Block (ISB) | Active Comparator | Single shot using US-guided interscalene brachial plexus block with 15 ml 0.5% ropivacaine and arthroscopic portals infiltration with 5 ml 0.75% diluted in 15 ml of distilled water. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Suprascapular nerve block | Procedure | The patient lies supine in beach chair position with surgical drapes on. The anatomical landmarks are outlined and the infiltration spot is identified. The block is performed with 10 ml ropivacaine 0.75%. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain intensity: Numeric Pain Rating Scale | Numeric Pain Rating Scale - no pain (0), unbearable pain (10) | 1 hour after surgery |
| Pain intensity: Numeric Pain Rating Scale | Numeric Pain Rating Scale - no pain (0), unbearable pain (10) | 24 hours after surgery |
| Pain intensity: Numeric Pain Rating Scale | Numeric Pain Rating Scale - no pain (0), unbearable pain (10) | 48 hours after surgery |
| Pain intensity: Numeric Pain Rating Scale | Numeric Pain Rating Scale - no pain (0), unbearable pain (10) | 72 hours after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Opiate Consumption | Total amount of narcotics consumed during the postoperative period measured in morphine equivalents (OME). | Postoperative hours 1-72 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ivan F Simionato, MD | Contact | +5551992077188 | simionato.md@gmail.com | |
| Rodrigo PG Barreto, PhD | Contact | +5551985861181 | rodrigopyy@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Marcelo F Silva, PhD | Federal University of Health Science of Porto Alegre | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Irmandade Santa Casa de Misericordia de Porto Alegre | Porto Alegre | Rio Grande do Sul | 90035072 | Brazil |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 16282408 | Background | Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ. 2005 Nov 12;331(7525):1124-8. doi: 10.1136/bmj.331.7525.1124. No abstract available. | |
| 23551432 | Background | Lindberg MF, Grov EK, Gay CL, Rustoen T, Granheim TI, Amlie E, Lerdal A. Pain characteristics and self-rated health after elective orthopaedic surgery - a cross-sectional survey. J Clin Nurs. 2013 May;22(9-10):1242-53. doi: 10.1111/jocn.12149. Epub 2013 Mar 29. |
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| ID | Term |
|---|---|
| D020069 | Shoulder Pain |
| D010149 | Pain, Postoperative |
| D000070636 | Rotator Cuff Injuries |
| D010146 | Pain |
| ID | Term |
|---|---|
| D018771 | Arthralgia |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D009461 | Neurologic Manifestations |
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2 groups of patients. Randomization into groups SSNB or ISB as per randomization list, for a total of 98 patients
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Triple (Participant, Investigator, and Outcomes Assessor)
| Interscalene Nerve Block | Procedure | The patient lies supine position with the head turned to the contralateral side to the block. A linear high-frequency ultrasound probe is used for identifying the roots of supraclavicular brachial plexus using the traceback technique. The block is performed with 15 ml ropivacaine 0.5%. |
|
|
| Arthroscopic rotator cuff repair | Procedure | Conventional arthroscopic rotator cuff repair. |
|
| 28898151 | Background | Desai N. Postoperative analgesia for shoulder surgery. Br J Hosp Med (Lond). 2017 Sep 2;78(9):511-515. doi: 10.12968/hmed.2017.78.9.511. |
| 28968280 | Background | Hussain N, Goldar G, Ragina N, Banfield L, Laffey JG, Abdallah FW. Suprascapular and Interscalene Nerve Block for Shoulder Surgery: A Systematic Review and Meta-analysis. Anesthesiology. 2017 Dec;127(6):998-1013. doi: 10.1097/ALN.0000000000001894. |
| 23353796 | Background | Vandepitte C, Gautier P, Xu D, Salviz EA, Hadzic A. Effective volume of ropivacaine 0.75% through a catheter required for interscalene brachial plexus blockade. Anesthesiology. 2013 Apr;118(4):863-7. doi: 10.1097/ALN.0b013e3182850dc7. |
| 24880194 | Background | Lee JJ, Kim DY, Hwang JT, Lee SS, Hwang SM, Kim GH, Jo YG. Effect of ultrasonographically guided axillary nerve block combined with suprascapular nerve block in arthroscopic rotator cuff repair: a randomized controlled trial. Arthroscopy. 2014 Aug;30(8):906-14. doi: 10.1016/j.arthro.2014.03.014. Epub 2014 May 29. |
| 31392721 | Background | Toma O, Persoons B, Pogatzki-Zahn E, Van de Velde M, Joshi GP; PROSPECT Working Group collaborators. PROSPECT guideline for rotator cuff repair surgery: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2019 Oct;74(10):1320-1331. doi: 10.1111/anae.14796. Epub 2019 Aug 7. |
| D012816 |
| Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D012421 | Rupture |
| D014947 | Wounds and Injuries |
| D000070599 | Shoulder Injuries |
| D013708 | Tendon Injuries |