Comparing Suprascapular Nerve Block and Interscalene Block for Post-thoracotomy Pain in Pediatric Patients.

Targeted Regional Analgesia for Post-Thoracotomy Ipsilateral Shoulder Pain in Pediatrics: Evaluating the Role of Suprascapular Nerve Block Versus Interscalene Block" A Randomized Controlled Study.

The goal of this clinical trial is to determine which regional block provides superior analgesia in pediatric patients undergoing thoracic surgery. The main questions it aims to answer are:

• Does one block technique provide better pain relief?
• Does the choice of block reduce opioid requirements and complication rates? Researchers will compare two block techniques to see if one offers an effective opioid-sparing strategy that improves patient comfort and reduces side effects.

Participants will:

• Receive one of the studied block interventions during thoracic surgery.
• Be monitored for postoperative pain scores, opioid consumption, and any complications.

This prospective randomized controlled trial aims to evaluate and compare the effectiveness and safety of two regional analgesic techniques-suprascapular nerve block (SSNB) and interscalene brachial plexus block (ISB)-for managing ipsilateral shoulder pain (ISP) following pediatric thoracotomy. ISP is a common and distressing postoperative complication, affecting 30-85% of thoracotomy patients, and is often poorly responsive to systemic opioids and thoracic epidural analgesia due to its referred pain origin via the phrenic and suprascapular nerves.

Identifying effective targeted analgesic strategies is therefore clinically important. The study will be conducted at Children's Cancer Hospital 57357 and will include 126 pediatric patients (5-18 years, ASA II-III) undergoing elective open thoracotomy.

Participants will be randomized into three groups:

• Thoracic epidural analgesia plus interscalene block.
• Thoracic epidural analgesia plus suprascapular nerve block.
• Thoracic epidural analgesia alone (control). Ultrasound-guided regional blocks will be administered using 0.25% bupivacaine (maximum 2 mg/kg) on the operative side. Postoperative pain scores will be assessed using the Numeric Rating Scale at 2, 4, 6, 12, and 24 hours, alongside total opioid consumption and adverse event monitoring.

The primary objective is to compare the analgesic efficacy of SSNB and ISB in reducing ISP after thoracotomy, while secondary outcomes include postoperative opioid requirements and complication rates. This study is significant because it addresses a persistent clinical challenge in pediatric thoracic surgery pain management. By identifying an effective opioid-sparing regional analgesic technique, the findings may improve postoperative comfort, reduce opioid-related side effects, enhance recovery, and inform evidence-based postoperative pain management protocols for pediatric thoracotomy patients.

Inclusion Criteria:

• ASA physical status II-III
• Elective open thoracotomy

Exclusion Criteria:

• Pre-existing shoulder pathology
• Coagulopathy or infection at injection site
• Allergy to local anesthetics
• Neurological disorders involving upper limb