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This study aims to compare the frequency of occurrence of ipsilateral shoulder pain in patients undergoing thoracotomy with ultrasound-guided interscalene block, anterior suprascapular block as adjunct to epidural and epidural block only.
Thoracotomy is one type of surgery associated with challenging pain that needs to be promptly addressed to avoid post-operative respiratory complications and aid in effective postoperative physiotherapy and patient recovery. Epidural analgesia is considered the gold standard for the thoracotomy procedure. Ipsilateral shoulder pain (ISP) following thoracotomy has an incidence ranging from 37% to 85%.
Being so common, this pain needs more attention and proper anticipation, and management. ISP is usually non-responsive to the effects of epidural and paravertebral blocks.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group (I) | Experimental | Patients will receive an ultrasound-guided interscalene block. |
|
| Group (S) | Experimental | Patients will receive an ultrasound-guided anterior suprascapular block. |
|
| Group (E) | Active Comparator | Patients will not receive regional blocks apart from epidural analgesia. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Interscalene block | Other | Patients will receive an ultrasound-guided interscalene block. |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Frequency of occurrence of ipsilateral shoulder pain | Frequency of occurrence of ipsilateral shoulder pain will be recorded. | 72 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Degree of pain | Each patient will be instructed about postoperative pain assessment with the visual analog scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be recorded after intensive care unit (ICU) admission then every 6 h postoperative for 72 h. | 72 hours postoperatively |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mai M Elrawas, MD | Contact | 00201222177242 | mai.elrawas@nci.cu.edu.eg |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cairo University | Recruiting | Cairo | 12613 | Egypt |
The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
After the end of study for one year.
The data will be available upon a reasonable request from the corresponding author.
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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 |
|---|---|
| D015360 | Analgesia, Epidural |
| ID | Term |
|---|---|
| D000698 | Analgesia |
| D000760 | Anesthesia and Analgesia |
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| Anterior suprascapular block |
| Other |
Patients will receive an ultrasound-guided anterior suprascapular block. |
|
| Epidural analgesia | Other | Patients will not receive regional blocks apart from epidural analgesia. |
|
| Mean arterial pressure |
Mean arterial pressure will be recorded every 30 minutes and immediately postoperative then every 4 h postoperative for 48 h. |
| 48 hours postoperatively |
| Heart rate | Heart rate will be recorded every 30 minutes and immediately postoperative then every 4 h postoperative for 48 h. | 48 hours postoperatively |
| Incidence of complications | Incidence of postoperative complications will be recorded. | 72 hours postoperatively |
| Time to first request of rescue analgesia | Rescue analgesia with 5 ml of 0.25% bupivacaine through the epidural catheter (in case of thoracotomy pain). Ketorolac 30 mg I.V. over 50 cc saline for breakthrough shoulder pain (will not exceed 120 mg/day). | 72 hours postoperatively |
| Total number of rescue analgesia | Total number of rescue analgesia will be recorded. | 72 hours postoperatively |
| Peak Expiratory Flow Rate | Peak Expiratory Flow Rate (PEFR) will be recorded as baseline in holding area before premedication and every 6 h postoperative for 72 h when visual analog scale (VAS) is ≤ 3. | 72 hours postoperatively |
| Forced Expiratory Volume in 1 second (FEV1) | Forced Expiratory Volume in 1 second (FEV1) will be recorded preoperative and at day 0, 1, 2 & 3 when visual analog scale (VAS) is ≤ 3. | 72 hours postoperatively |
| Forced vital capacity (FVC) | Forced vital capacity (FVC) will be recorded preoperative and at day 0, 1, 2 & 3 when visual analog scale (VAS) is ≤ 3. | 72 hours postoperatively |
| Forced Expiratory Volume in 1 second (FEV1) / Forced vital capacity (FVC) ratio | Forced Expiratory Volume in 1 second (FEV1) / Forced vital capacity (FVC) ratio will be recorded preoperative and at day 0, 1, 2 & 3 when visual analog scale (VAS) is ≤ 3. | 72 hours postoperatively |
| D009461 |
| Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |