Post-Operative Analgesic Efficacy Of Ultrasound Guided Pericapsular Nerve Group Block Versus Combined Suprascapular And Axillary (Circumflex) Nerve Block For Patients Undergoing Shoulder Arthroscopy

NCT05791058 | Unknown

• 1 other identifier: Ain Shams university 17
• Study Type: interventional
• Target: 75
• Locations: 0 countries
• Sites: N/A

Brief Summary

Recently, the Combined suprascapular nerve block and axillary nerve block (SSNB+ANB) was proposed to provide anesthesia and postoperative analgesia for shoulder surgery as a safe alternative to interscalene block. These two peripheral nerves are responsible for the majority of the sensory innervation of the shoulder. PENG block has been studied extensively in hip surgeries, but its place in shoulder surgeries is not yet clear. It is a new technology reported for block of articular branches of the shoulder and well pericapsular spread around the glenohumeral joint Therefore, achieving pain relief while avoiding motor block allows us not only to provide an early rehabilitation program in the postoperative period, but also to control the chronic nociceptive activation secondary to pain-induced movement

Conditions

Post Operative Pain

Outcome Measures

Primary Outcomes (9)

• visual analogue score

  A scale from 0-10 was allocated with 0 representing no pain and 10 representing the worst imaginable pain

  immediately after extubation

• visual analogue score

  A scale from 0-10 was allocated with 0 representing no pain and 10 representing the worst imaginable pain

  2 hours postoperative

• visual analogue score

  A scale from 0-10 was allocated with 0 representing no pain and 10 representing the worst imaginable pain

  4 hours postoperative

• visual analogue score

  A scale from 0-10 was allocated with 0 representing no pain and 10 representing the worst imaginable pain

  8 hours postoperative

• visual analogue score

  A scale from 0-10 was allocated with 0 representing no pain and 10 representing the worst imaginable pain

  12 hours postoperative

• visual analogue score

  A scale from 0-10 was allocated with 0 representing no pain and 10 representing the worst imaginable pain

  16 hours postoperative

• visual analogue score

  A scale from 0-10 was allocated with 0 representing no pain and 10 representing the worst imaginable pain

  24 hours postoperative

• visual analogue score

  A scale from 0-10 was allocated with 0 representing no pain and 10 representing the worst imaginable pain

  36 hours postoperative

• visual analogue score

  A scale from 0-10 was allocated with 0 representing no pain and 10 representing the worst imaginable pain

  48 hours postoperative

Secondary Outcomes (3)

• Time time to first dose of rescue analgesic

  during 48 hours after operation

• Total dose of analgesic needed

  during 48 hours after operation

• Complications

  during 48 hours after operation

Study Arms (3)

Group A (ultrasound guided pericapsular nerve group shoulder block)

ACTIVE COMPARATOR

Procedure: ultrasound guided pericapsular nerve group shoulder block

Group B( ultrasound guided suprascapular and axillary nerve block)

ACTIVE COMPARATOR

Procedure: ultrasound guided suprascapular and axillary nerve block

control group

ACTIVE COMPARATOR

Other: general anesthesia without nerve block

Interventions

ultrasound guided pericapsular nerve group shoulder block PROCEDURE

The patient's arm is placed in external rotation and abducted at 45 degrees. A linear ultrasound probe will be placed longitudinally between the coracoid and the humeral head. After defining the humeral head, the tendon of the subscapular muscle and the deltoid muscle over it, a 50-mm needle will be inserted using the ''in plane'' technique. When the needle pass through the deltoid muscle and touched the subscapularis tendon, a bone-like hard tissue will be felt and the needle could not be advanced further. The needle tip will be placed between the deltoid muscle and subscapularis tendon, and 20 cc of 0.25% bupivacaine hydrochloride with 4mg dexamesathone will be injected

Group A (ultrasound guided pericapsular nerve group shoulder block)

ultrasound guided suprascapular and axillary nerve block PROCEDURE

The patient will be positioned in a semi-recumbent position with the operating arm on the contralateral shoulder. The probe will be kept over the scapular spine to identify the trapezius and the supraspinatus muscle. Then, it will be moved laterally to identify the concavity of the supraspinatus fossa and the hyper-echoic fascia of the supraspinatus muscle. In the concavity of the fossa, the suprascapular artery and the suprascapular nerve run in close proximity. 10 ml of 0.25% bupivacaine with 2mg dexamethasone will be injected below the supraspinatous fascia then the posterior surface of the humerus will be visualised in the short axis view. So, the AN and posterior circumflex artery will be visualised longitudinally. 10 ml of 0.25% bupivacaine with 2mg dexamethasone will be injected into space

Group B( ultrasound guided suprascapular and axillary nerve block)

general anesthesia without nerve block OTHER

this group will receive general anesthesia without nerve block

control group

Eligibility Criteria

• Age: 18 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Adults between age of 18 and 60 years old undergoing elective shoulder arthroscopy surgery.
• American society of anesthesiologists classification (ASA) Ⅰ\&Ⅱ
• Males \& Females

You may not qualify if:

• Age: \< 18 or \> 60 years old.
• Patients refuse to participate in the study.
• Patients with known hypersensitivity to local anesthetics.
• Coagulation disorder
• Infection at the site of injection
• Hepatic impairment
• Renal impairment
• Severe intraoperative bleeding affecting the hemodynamics status of the patient.

Sponsors & Collaborators

• Ain Shams University: lead

MeSH Terms

Conditions

Pain, Postoperative

Interventions

Anesthesia, General; Nerve Block

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Intervention Hierarchy (Ancestors)

Anesthesia; Anesthesia and Analgesia; Anesthesia, Conduction; Denervation; Neurosurgical Procedures; Surgical Procedures, Operative

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor of Anesthesia

Study Record Dates

• First Submitted: March 17, 2023
• First Posted: March 30, 2023
• Study Start: May 20, 2023
• Primary Completion: May 20, 2023
• Study Completion: May 20, 2024
• Last Updated: March 30, 2023

Record last verified: 2023-03

Data Sharing

• IPD Sharing: Will not share