This randomized controlled trial aims to compare the analgesic efficacy and safety of a Modified Pericapsular Nerve Group (PENG) Block combined with Suprascapular Nerve Block (SSNB) versus Interscalene Brachial Plexus Block (ISB) in adult patients undergoing elective Bankart repair or Latarjet surgery under general anesthesia. Seventy patients will be randomized to receive either Modified PENG plus SSNB or ISB. The primary outcome is postoperative pain intensity measured by the Visual Analog Scale (VAS) at 24 hours. Secondary outcomes include opioid consumption, time to first rescue analgesia, functional recovery, range of motion, and block-related complications including respiratory compromise, motor weakness, Horner syndrome, hoarseness, and local anesthetic systemic toxicity. This randomized controlled trial aims to compare the analgesic efficacy and safety of a Modified Pericapsular Nerve Group (PENG) Block combined with Suprascapular Nerve Block (SSNB) versus Interscalene Brachial Plexus Block (ISB) in adult patients undergoing elective Bankart repair or Latarjet surgery under general anesthesia. Seventy patients will be randomized to receive either Modified PENG plus SSNB or ISB. The primary outcome is postoperative pain intensity measured by the Visual Analog Scale (VAS) at 24 hours. Secondary outcomes include opioid consumption, time to first rescue analgesia, functional recovery, range of motion, and block-related complications including respiratory compromise, motor weakness, Horner syndrome, hoarseness, and local anesthetic systemic toxicity.

Shoulder stabilization procedures such as Bankart repair and the Latarjet procedure are associated with significant postoperative pain. The interscalene brachial plexus block is considered the standard regional anesthetic technique but is associated with complications including phrenic nerve paralysis and motor weakness. This study evaluates whether a Modified PENG Block combined with Suprascapular Nerve Block can provide comparable postoperative analgesia while reducing block-related complications. This is a prospective, single-center, randomized controlled trial involving 70 ASA I-II adult patients undergoing elective shoulder stabilization surgery at Kasr Al-Ainy Hospital, Cairo University. Participants will be randomly allocated to receive either Modified PENG plus SSNB or ISB before general anesthesia. Pain scores, opioid consumption, time to first rescue analgesia, functional recovery, hemodynamic parameters, and adverse events will be assessed during the first 24 postoperative hours and during follow-up according to the study protocol

Inclusion Criteria:

• • Male or female patients aged 18 to 65 years.

  • Patients undergoing elective Bankart repair or Latarjet surgery.
  • American Society of Anesthesiologists (ASA) physical status I or II.

Exclusion • Patient refusal.

• History of allergy to local anesthetics.
• Chronic opioid use (>3 months).
• Coagulation disorders.
• Pre-existing neurological or musculoskeletal disorders.
• Respiratory compromise (e.g., COPD)

Individual participant data will not be shared because there is no plan for public data sharing. Only aggregated study results will be reported in scientific publications while maintaining participant confidentiality.Individual participant data will not be shared because there is no plan for public data sharing. Only aggregated study results will be reported in scientific publications while maintaining participant confidentiality.

Participants and outcome assessors will be blinded to treatment allocation. Randomization will be performed using computer-generated random numbers and sealed opaque envelopes. The anesthesiologist performing the block will not be blinded because of the nature of the intervention