Combined ASSNB and ICBPB vs CCBPB in Shoulder Arthroscopy

NCT06973447 | Completed

• 1 other identifier: 2024-01/08
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

The aim is to compare the postoperative analgesic and hemidiaphragmatic effects of Anterior SupraScapular Nerve Block (ASSNB) and InfraClavicular Brachial Plexus Block (ICBPB) combination versus CostoClavicular Brachial Plexus Block (CCBPB) in patients undergoing shoulder arthroscopic surgery.

Conditions

Postoperative Pain; Shoulder Arthroscopy

Keywords

postoperative pain; shoulder arthroscopy; regional anesthesia; costoclavicular brachial plexus block; infraclavicular brachial plexus block; anterior suprascapular nerve block

Outcome Measures

Primary Outcomes (2)

• Numeric Rating Scale (NRS) Scores

  Numerical rating scale is used for pain assessment. The scores of the numerical rating scale changes between 0 to 10 points. 10 points mean "the most severe pain that the patient ever had". 0 point means "there is no pain." Higher scores mean worse outcome.

  Postoperative 24 hours

• Diaphragmatic Excursion Difference

  Ipsilateral diaphragmatic excursions will be measured both preoperatively right before the anesthesia induction, and postoperatively after 30 minutes of emergence from anesthesia (upon reaching 9 points on modified Aldrete scoring). A diaphragmatic excursion change of up to 25% indicates no nerve involvement, a change between 25%-75% indicates partial involvement, and a change exceeding 75% indicates complete involvement of the phrenic nerve.

  Preoperatively right before the anesthesia induction, and postoperatively after 30 minutes of emergence from anesthesia (upon reaching 9 points on modified Aldrete scoring)

Secondary Outcomes (2)

• Quality of Recovery-15 Patient Survey (QoR-15)

  Preoperatively and Postoperatively at 24th hour

• Total tramadol consumption

  Postoperative 24 hours

Study Arms (2)

Combined ASSNB and ICBPB

ACTIVE COMPARATOR

For this group, ASSNB and ICBPB blocks will be performed on the ipsilateral side of the patient right after the anesthesia induction with the patients in supine position. For ICBPB, a high frequency linear transducer USG is placed over the lateral infraclavicular fossa in a sagittal orientation medial to the coracoid process and caudal to the clavicle. The block needle is inserted in-plane from a cephalad-to-caudal direction, just inferior to the clavicle to pass through the pectoralis major and minor muscles, aiming toward the posterior aspect of the axillary artery. 15 mL of 0.25% bupivacaine is administered. For ASSNB, the transducer is positioned in a sagittal oblique orientation over the supraclavicular fossa to image the subclavian artery and the brachial plexus. While tracing the plexus craniocaudally, the suprascapular nerve is identified. The needle is advanced in-plane from posterior to anterior. 10 mL of 0.25% bupivacaine is administered.

Procedure: Anterior suprascapular nerve block (ASSNB); Procedure: Infraclavicular Brachial Plexus Block (ICBPB)

CCBPB

ACTIVE COMPARATOR

For this group, CCBPC will be performed on the ipsilateral side of the patient right after the anesthesia induction with the patients in supine position. For CCBPB, a high frequency linear transducer of the USG is placed in the medial infraclavicular fossa parallel and next to the clavicle to identify the axillary artery. The transducer is then tilted cephalad to image the brachial plexus and the artery in a perpendicular orientation between the subclavius muscle and the serratus anterior. The needle is advanced in-plane in a lateral-to-medial direction, adjusting the angle to reach the space in between the three cords. 15 mL of 0.25% bupivacaine is administered.

Procedure: Costoclavicular brachial plexus block (CCBPB)

Interventions

Anterior suprascapular nerve block (ASSNB) PROCEDURE

10 mL of 0.25% bupivacaine

Combined ASSNB and ICBPB

Infraclavicular Brachial Plexus Block (ICBPB) PROCEDURE

15 mL of 0.25% bupivacaine

Combined ASSNB and ICBPB

Costoclavicular brachial plexus block (CCBPB) PROCEDURE

15 mL of 0.25% bupivacaine

CCBPB

Eligibility Criteria

• Age: 18 Years - 85 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adult patients older than 18 years of age who underwent arthroscopic shoulder surgery under general anesthesia and were American Society of Anesthesiologists (ASA) I-II-III according to the ASA risk classification.

You may not qualify if:

• patients who did not give consent,
• patients with coagulopathy,
• patients with signs of infection at the block application site,
• patients using anticoagulants,
• patients with local anesthetic drug allergies,
• patients with unstable hemodynamics,
• patients who could not cooperate during postoperative pain assessment

Sponsors & Collaborators

• Cumhuriyet University: lead

Study Sites (1)

Sivas Cumhuriyet University

Sivas, Sivas, 58140, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Pain, Postoperative

Condition Hierarchy (Ancestors)

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

Study Officials

• Oğuz Gündoğdu

  Sivas Cumhuriyet University School of Medicine, Anesthesiology and Reanimation

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: May 7, 2025
• First Posted: May 15, 2025
• Study Start: January 30, 2024
• Primary Completion: September 30, 2025
• Study Completion: September 30, 2025
• Last Updated: December 29, 2025

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)