Interscalene Versus Costoclavicular Blocks for Shoulder Surgery

NCT06953947 | Completed

• 1 other identifier: E-16214662-050.01.04-176689116
• Study Type: interventional
• Target: 62
• Locations: 1 country
• Sites: 1

Brief Summary

AIM: Shoulder surgeries are among the most painful surgical procedures in orthopedic practice. Interscalene brachial plexus block, although the most commonly utilized regional anesthesia technique for alleviating pain following shoulder surgery, may result in complications such as hemidiaphragmatic paresis, hoarseness. More distal blocks along the brachial plexus may provide postoperative analgesia while potentially having less effect on respiratory functions. The aim of this study is to determine whether there are differences in postoperative pain scores and opioid consumption between interscalene block (ISB) and costoclavicular brachial plexus block (CCB). MATERIALS AND METHODS: Following ethical approval, all eligible patients undergoing for shoulder surgery under general anesthesia between 01.11.2022 and 01.11.2023 will be enrolled and to be divided into two groups following written informed consent, with one group receiving ISB and the other group receiving CCB. A blinded researcher will record pain scores at postoperative 0.5, 1, 6, 12, 18, and 24 hours. Demographic data of patients, postoperative opioid consumption, time to first analgesic request, rescue analgesic requirements, adverse effects and hemodynamic parameters will be compared statistically.

Conditions

Postoperative Pain; Shoulder Surgeries Operations; Regional Anesthesia; Costoclavicular Block; Interscalene Blocks

Keywords

analgesia; brachial plexus; postoperative pain; shoulder surgery

Outcome Measures

Primary Outcomes (1)

• Postoperative Pain Measurement

  The pain measurements of the patients after surgery which evaluated with visual analogue scale (VAS), ranging from 0 to 10 while 0 describes no pain at all and 10 describes the most severe pain a person can experience.

  Measured at Postoperative 0.5, 1, 6, 12, 18, and 24 hours

Secondary Outcomes (4)

• Postoperative Opioid Consumption

  Postoperative 24 hours.

• Time to first analgesic request

  Postoperative 24 hours

• Rescue analgesic requirements

  Postoperative 24 hours

• Adverse effects

  Postoperative 24 hours

Study Arms (2)

Group CCB

EXPERIMENTAL

The group of patients which received costoclavicular block

Procedure: Costoclavicular block; Drug: Costoclavicular block

Group ISB

EXPERIMENTAL

The group of patients which received interscalene block

Procedure: Interscalene block; Drug: Interscalene Nerve Block

Interventions

Costoclavicular block PROCEDURE

The costoclavicular block was first described by Karmakar et al. in 2015. It is a type of brachial plexus block that targets the three cords located lateral to the axillary artery within the costoclavicular space. The costoclavicular space is defined as the area between the middle third of the clavicle and the anterior thoracic wall. Within this space, the cords of the brachial plexus are situated lateral to the axillary artery, positioned between the pectoralis major, subclavius, and serratus anterior muscles. In contrast to the traditional infraclavicular approach, the cords in the costoclavicular block are located more superficially and are more consistently clustered lateral to the axillary artery, which may facilitate visualization and needle targeting. After the needle is placed between the three cords under ultrasound guidance, the local anesthetic (20 mL of 0.25% bupivacaine) is injected.

Group CCB

Interscalene block PROCEDURE

Originally described by Etienne in 1925, the technique was later refined into its modern clinical form by Alon Winnie in 1970. The interscalene approach, primarily preferred for shoulder surgeries, aims to target the upper roots of the brachial plexus (C5-C7). In interscalene block, a needle is placed under ultrasound guidance around the upper and middle trunks of the brachial plexus, which pass through the space between the anterior and middle scalene muscles, and the local anesthetic (20 mL of 0.25% bupivacaine) is injected while its spread is observed.

Group ISB

Interscalene Nerve Block DRUG

In interscalene block, using an ultrasound probe placed on the neck, the course of the brachial plexus trunks between the anterior and middle scalene muscles is visualized. Then, after the needle is inserted under ultrasound guidance between the anterior and middle scalene muscles, 20 mL of 0.25% bupivacaine is injected as the local anesthetic.

Group ISB

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients undergoing unilateral shoulder surgery
• ASA (American Society of Anesthesiology) class I, II and III patients

You may not qualify if:

• Coagulopathy
• Chronic Pulmoner Disease
• Hypersensitivity to local anesthetics
• Ipsilateral neurological deficits
• Non-communicative patients

Sponsors & Collaborators

• Sakarya University: lead

Study Sites (1)

Sakarya University Training and Research Hospital

Sakarya, 54290, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Pain, Postoperative; Agnosia

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms; Perceptual Disorders; Neurobehavioral Manifestations; Nervous System Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: A blinded researcher recorded pain scores at postoperative 0.5, 1, 6, 12, 18, and 24 hours
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Anesthesiology and Reanimation Specialist, M.D.

Model Details: A total of 62 patients undergoing for shoulder surgery under general anesthesia between 01.11.2022 and 01.11.2023 were divided into two groups following written informed consent, with one group receiving ISB and the other group receiving CCB. A blinded researcher recorded pain scores at postoperative 0.5, 1, 6, 12, 18, and 24 hours

Study Record Dates

• First Submitted: April 5, 2025
• First Posted: May 1, 2025
• Study Start: October 1, 2022
• Primary Completion: March 15, 2024
• Study Completion: March 16, 2024
• Last Updated: May 1, 2025

Record last verified: 2025-04

Locations

TU (1)