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This study aimed to evaluate the effectiveness of serratus posterior superior intercostal plane (SPSIP) block in managing postoperative pain in patients undergoing arthroscopic shoulder surgery.
Most patients undergoing arthroscopic shoulder surgery report pain in the postoperative period. Pain management remains a significant concern in patient management, as it affects surgical costs, postoperative mobility, length of hospital stay, patient satisfaction, and surgical outcomes. Multimodal analgesia is recommended for the management of postoperative pain. Regional analgesia is an important component of multimodal analgesia.
The serratus posterior superior intercostal plane (SPSIP) block is a novel regional analgesia technique described in 2023. SPSIP has been reported to provide near-complete sensory blockade in the posterior neck, shoulder, and hemithorax regions.
The main objective of this study is to investigate the effectiveness of SPSIP block in patients undergoing arthroscopic shoulder surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group SPSIP | Active Comparator | Group SPSIP Participants in this arm will receive an ultrasound-guided serratus posterior plane block . |
|
| Group Control | No Intervention | No block procedures will be performed on patients in this arm |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Group SPSIP: Serratus Posterior Superior İntercostal Plane Block (SPSIP) | Procedure | Serratus Posterior Superior İntercostal Plane (SPSIP) Block will be performed before the surgery in seated position, under standard sterilization conditions.A linear ultrasound probe will be placed in the sagittal plane along the medial border of the scapula, and the second and third ribs, relevant muscles, and the pleura will be identified. The needle will be advanced into the interfascial plane between the serratus posterior superior and intercostal muscles. After confirmation with salin injection , the block will be performed by injecting 30 mL of 0.25% bupivacaine, and the cranio-caudal spread will be visualized under ultrasound. |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative 48-Hour PCA Opioid Consumption | Total amount of opioid delivered by the patient-controlled analgesia (PCA) device during the first 48 hours after surgery, recorded in milligrams(mg) | Postoperative 0-8, 8-16, 16-24, 24-48 intervals |
| Measure | Description | Time Frame |
|---|---|---|
| QoR-15 Recovery Score | The investigators will use the Turkish version of Quality of Recovery (QoR) / QoR-15 questionairre PART A How have you been feeling in the last 24 hours? (0 to 10, where: 0 = none of the time [poor] and 10 = all of the time [excellent]) Able to breathe easily Been able to enjoy food Feeling rested Have had a good sleep Able to look after personal toilet and hygiene unaided Able to communicate with Getting support from hospital doctors and nurses Able to return to work or usual home activities Feeling comfortable and in control Having a feeling of general well-being PART B Have you had any of the following in the last 24 hours? (10 to 0, where: 10 = none of the time [excellent] and 0 = all of the time [poor]) Moderate pain Severe pain Nausea or vomiting Feeling worried or anxious Feeling sad or depressed |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mursel Ekinci, Assoc prof, MD | Contact | +905067137596 | drmurselekinci@gmail.com | |
| Merih Yıldız Eglen, MD | Contact | +905059340629 | Meriheg@yahoo.com |
| Name | Affiliation | Role |
|---|---|---|
| Merih Yıldız Eglen, MD | Bursa City Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Bursa City Hospital | Recruiting | Bursa | 16110 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38343684 | Background | Avci O, Gundogdu O, Balci F, Tekcan MN, Ozbey M. Efficacy of serratus posterior superior intercostal plane block (SPSIPB) on post-operative pain and total analgesic consumption in patients undergoing video-assisted thoracoscopic surgery (VATS): A double-blinded randomised controlled trial. Indian J Anaesth. 2023 Dec;67(12):1116-1122. doi: 10.4103/ija.ija_589_23. Epub 2023 Dec 13. | |
| 38414179 |
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Active Comparator: Group SPSIP: Participants in this arm will receive an ultrasound-guided serratus posterior superior intercostal plane block before the surgery. Patients will be taken to the operating room after sensory and motor block assessment.
Control group: No block procedures will be performed on patients in this arm. Both groups will receive general anesthesia using the standard anesthesia method; induction with lidocaine, propofol, fentanyl, and rocuronium. Maintenance will be provided by inhalation anesthesia and remifentanil infusion. Before the end of surgery, all patients will receive paracetamol, Tramadol, and Tenoxicam intravenously as standard postoperative analgesia.
After surgery, patients will be extubated and taken to the post-anesthesia care unit. Patient-controlled analgesia devices will be attached to all patients in the post-anesthesia care unit.
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|
| Postoperative 24th and 48th hours |
| Dynamic and static NRS scores | Numeric Rating Scale (NRS) (0-10 0: No pain 10: most pain felt) pain scores at rest or movement at predefined postoperative hours | 0, 2, 4, 8, 16, 24, and 48 hours postoperatively |
| Total rescue analgesic dose | Despite the use of patient-controlled analgesia (PCA), if the Numeric Rating Scale (NRS) score is ≥4 at any time point, 0.5 mg/kg intravenous meperidine will be administered as | Postoperative 24th and 48th hours |
| Time of first request for rescue analgesia, | Despite the use of patient-controlled analgesia (PCA), if the Numeric Rating Scale (NRS) score is ≥4 at any time point, 0.5 mg/kg intravenous meperidine will be administered. The time will be recorded. | Postoperative 48-Hours |
| Length of Hospital Stay | Number of days spent in hospital after surgery | the day of surgery, the day of discharge from the hospital |
| Block and Opioid-Related Adverse Effects and Complications | Block- and opioid-related adverse effects and complications, including but not limited to local anesthetic toxicity, hematoma, infection, nerve injury, nausea, vomiting, pruritus, sedation, and respiratory depression, will be recorded | Postoperative 48-Hours |
| Perioperative Remifentanil infusion dose | The amount of remifentanil administered in micrograms during general anesthesia | Start time: Start of anesthesia administration End time: Termination of anesthesia administration |
| Background |
| Kulturoglu G, Altinsoy S, Ozguner Y, Cataroglu CK. Novel Serratus Posterior Superior Intercostal Plane Block Provided Satisfactory Analgesia after Breast Cancer Surgery: Two Case Reports. Turk J Anaesthesiol Reanim. 2024 Feb 28;52(1):33-35. doi: 10.4274/TJAR.2024.231431. |
| 36883093 | Background | Tulgar S, Ciftci B, Ahiskalioglu A, Bilal B, Sakul BU, Korkmaz AO, Bozkurt NN, De Cassai A, Torres AJ, Elsharkawy H, Alici HA. Serratus Posterior Superior Intercostal Plane Block: A Technical Report on the Description of a Novel Periparavertebral Block for Thoracic Pain. Cureus. 2023 Feb 3;15(2):e34582. doi: 10.7759/cureus.34582. eCollection 2023 Feb. |
| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D020069 | Shoulder Pain |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D018771 | Arthralgia |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
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