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Interscalene block is widely accepted as the gold-standard regional analgesic technique for pain control after arthroscopic shoulder surgery. However, because this block is performed at the level of the brachial plexus roots, it may be associated with adverse effects such as phrenic nerve blockade and subsequent diaphragmatic dysfunction. These limitations have prompted the search for alternative regional anesthesia techniques that can provide effective postoperative analgesia while preserving respiratory function.
The anterior suprascapular block, which covers a broad dermatomal distribution of the shoulder region, has been shown in some studies to provide sufficient analgesia as a standalone technique. In addition, the pericapsular nerve group (PENG) block of the shoulder-applied around the anterior capsule and performed at a distance from critical neurovascular structures that may lead to serious complications-may represent another potential analgesic option following arthroscopic shoulder procedures.
Therefore, this study aims to evaluate alternative regional block techniques in comparison with the interscalene block and to contribute to the identification of an optimal analgesic strategy after arthroscopic shoulder surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Interscalene block | Active Comparator | In the preoperative period, 10 mL of 0.25% bupivacaine will be injected between C5 and C6 using an in-plane technique guided by a linear ultrasound (US) probe. |
|
| Anterior suprascapular block | Active Comparator | A linear ultrasound probe will be positioned in the supraclavicular fossa, parallel to the clavicle. The suprascapular nerve will be identified as a hyperechoic oval structure deep to the omohyoid muscle and posterior-lateral to the brachial plexus. 10 mL of local anesthetic will be injected under the omohyoid muscle, around the suprascapular nerve. |
|
| Pericapsular nerve group (PENG) block | Active Comparator | A linear ultrasound probe will be placed sagittally, near the axillary region, just below the coracoid process. The subscapularis muscle and its tendon will be visualized. The target area is the space between the deep fascia of the subscapularis muscle and the anterior surface of the shoulder joint capsule. The needle will pass the subscapularis muscle and be guided into the plane between the capsule and the muscle, where 20 mL of local anesthetic will be dispensed to block the articular branches innervating the capsule. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Interscalene block | Procedure | Interscalene block will be performed, under US guidance, before the surgical operation, and when the patient is placed in the supine position. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Pain scores | Pain will be assessed at rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 100 (worst pain) at the first postoperative hour. | First hour after the surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Pain scores | Pain will be assessed at rest and while coughing using the visual analog scale on a scale from 0 (no pain) to 100 (worst pain). Pain assessment will be done at the 1st, 2nd, 6th, 12th, and 24th hours after surgery. | First 24 hours after surgery |
| Forced vital capacity (FVC) (volume) |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ankara Etlik City Hospital | Recruiting | Yenimahalle | Ankara | 06170 | Turkey (Türkiye) |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D059787 | Acute Pain |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| ID | Term |
|---|---|
| D003766 | Dental Occlusion |
| ID | Term |
|---|---|
| D003813 | Dentistry |
| D009063 | Dental Physiological Phenomena |
| D055688 | Digestive System and Oral Physiological Phenomena |
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| Anterior suprascapular block | Procedure | Anterior suprascapular block will be performed, under US guidance, before the surgical operation, and when the patient is placed in the supine position. |
|
| Pericapsular nerve group (PENG) block | Procedure | Pericapsular nerve group (PENG) block will be performed, under US guidance, before the surgical operation, and when the patient is placed in the supine position. |
|
Forced vital capacity (FVC) (volume) will be evaluated during the perioperative period. Measurements will be performed before block administration (baseline), at 30 minutes after the block, and at postoperative 1, 12, and 24 hours. |
| Perioperative period |
| Forced expiratory flow in 1 s (FEV1) (volume) | Forced expiratory flow in 1 s (FEV1) (volume) will be evaluated during the perioperative period. Measurements will be performed before block administration (baseline), at 30 minutes after the block, and at postoperative 1, 12, and 24 hours. | Perioperative period |
| FEV1/FVC | FEV1/FVC will be evaluated during the perioperative period. Measurements will be performed before block administration (baseline), at 30 minutes after the block, and at postoperative 1, 12, and 24 hours. | Perioperative period |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |