Interscalene Versus Infraspinatus-Teres Minor Blocks for Arthroscopic Shoulder Surgery

NCT07253740 | Recruiting

• 1 other identifier: ATAUNISHOULDER
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial aims to compare the effectiveness of interscalene (ISB) and infraspinatus-teres minor (ITM) blocks for postoperative analgesia in patients undergoing elective arthroscopic shoulder surgery. The primary outcome is total 24-hour opioid consumption. Secondary outcomes include pain scores, hemidiaphragmatic paresis incidence and severity, duration of analgesia, and changes in lung function. Participants are randomized into ISB or ITM groups; blocks are performed under ultrasound guidance. Postoperative pain is managed with patient controlled analgesia(PCA).

Conditions

Arthroscopic Shoulder Surgery

Keywords

Postoperative Pain; Analgesia; Regional Anesthesia; Interscalene Brachial Plexus Block; Infraspinatus-Teres Minor Block

Outcome Measures

Primary Outcomes (1)

• Total 24-Hour Postoperative Opioid Consumption

  Total intravenous opioid consumption recorded for each patient during the first 24 hours after arthroscopic shoulder surgery, including any rescue analgesia administered.

  0-24 hours postoperatively

Secondary Outcomes (4)

• Incidence and Severity of Hemidiaphragmatic Paresis

  Pre-block and 30 minutes post-block

• Duration of Analgesia

  0-24 hours post-block

• Pulmonary Function Changes (FEV1)

  Pre-block and 30 minutes post-block

• Pulmonary Function Changes (FVC)

  Pre-block and 30 minutes post-block

Study Arms (2)

Interscalene Brachial Plexus Block (ISB)

EXPERIMENTAL

Patients will receive ISB under ultrasound guidance prior to arthroscopic shoulder surgery using 15 ml 0.25% bupivacaine.

Procedure: Interscalene Brachial Plexus Block (ISB)

Infraspinatus-Teres Minor Block (ITM)

EXPERIMENTAL

Patients will receive TM block under ultrasound guidance using 25 ml 0.25% bupivacaine between infraspinatus and teres minor muscles.

Procedure: Infraspinatus-Teres Minor Block (ITM)

Interventions

Interscalene Brachial Plexus Block (ISB) PROCEDURE

Patients receive ultrasound-guided ISB before arthroscopic shoulder surgery. After sedation with IV midazolam, 15 ml of 0.25% bupivacaine is injected using a 22 Gauge 50 mm needle with posterior in-plane approach, targeting C5-C6 roots.

Also known as: Interscalene Nerve Block

Interscalene Brachial Plexus Block (ISB)

Infraspinatus-Teres Minor Block (ITM) PROCEDURE

Patients receive ultrasound-guided ITM interfascial block in sitting position before surgery. Using a 22 Gauge 10 mm needle, 25 ml of 0.25% bupivacaine is injected between infraspinatus and teres minor muscles via out-of-plane or in-plane hydrodissection.

Infraspinatus-Teres Minor Block (ITM)

Eligibility Criteria

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

You may qualify if:

• The American Society of Anesthesiologists I-III
• Scheduled for elective unilateral arthroscopic shoulder surgery
• Provide written informed consent

You may not qualify if:

• Refusal to participate
• Allergy to study drugs
• Severe cardiac, renal, or hepatic disease
• Neurological deficit or neuropathy
• Anticoagulant therapy
• Pre-existing respiratory dysfunction
• Chronic shoulder pain or planned open surgery

Sponsors & Collaborators

• Ataturk University: lead

Study Sites (1)

Ataturk University

Erzurum, 25000, Turkey (Türkiye)

RECRUITING

Related Publications (7)

• Renes SH, Rettig HC, Gielen MJ, Wilder-Smith OH, van Geffen GJ. Ultrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis. Reg Anesth Pain Med. 2009 Sep-Oct;34(5):498-502. doi: 10.1097/AAP.0b013e3181b49256.

  PMID: 19920426 BACKGROUND

• Kim SH, Yeo IS, Jang J, Jung HE, Chun YM, Yang HM. Infraspinatus-teres minor (ITM) interfascial block: a novel approach for combined suprascapular and axillary nerve block. Reg Anesth Pain Med. 2024 Jan 11;49(1):67-72. doi: 10.1136/rapm-2023-104738.

  PMID: 37491150 BACKGROUND

• Kang R, Jeong JS, Chin KJ, Yoo JC, Lee JH, Choi SJ, Gwak MS, Hahm TS, Ko JS. Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery. Anesthesiology. 2019 Dec;131(6):1316-1326. doi: 10.1097/ALN.0000000000002919.

  PMID: 31490292 BACKGROUND

• Teske LG, Pill SG, Lutz A, Thigpen CA, Shanley E, Adams KJ, Bohon H, Graham GD, Marston G, Walker KB, Kissenberth MJ. Single shot interscalene regional anesthesia provides noninferior analgesia and decreased complications compared with an indwelling catheter for arthroscopic and reconstructive shoulder surgery. J Shoulder Elbow Surg. 2022 Jun;31(6S):S152-S157. doi: 10.1016/j.jse.2022.02.004. Epub 2022 Mar 15.

  PMID: 35301140 BACKGROUND

• Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, Glaser SE, Vallejo R. Opioid complications and side effects. Pain Physician. 2008 Mar;11(2 Suppl):S105-20.

  PMID: 18443635 BACKGROUND

• Luan H, Hao C, Li H, Zhang X, Zhao Z, Zhu P. Effect of interscalene brachial plexus block with dexmedetomidine and ropivacaine on postoperative analgesia in patients undergoing arthroscopic shoulder surgery: a randomized controlled clinical trial. Trials. 2023 Jun 12;24(1):392. doi: 10.1186/s13063-023-07292-2.

  PMID: 37308994 BACKGROUND

• Ahiskalioglu A, Karapinar YE, Dagci Y, Yayik AM, Ciftci B, Tulgar S. An alternative sonographic approach to infraspinatus-teres minor interfascial plane block: make it easy. Minerva Anestesiol. 2025 Apr;91(4):359-361. doi: 10.23736/S0375-9393.24.18697-X. Epub 2025 Feb 6. No abstract available.

  PMID: 39912574 BACKGROUND

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 Officials

• Ali Ahıskalıoğlu, Professor

  Ataturk University Department of Anesthesiology and Reanimation

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Ali Ahıskalıoğlu, Professor

CONTACT

+90-554-442-48-31; aliahiskalioglu@hotmail.com

Ramazan Altunkaynak, MD

CONTACT

+90-553-811-95-44; 4444ramazan23@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Masking Details: The anesthesiologist performing the blocks is aware of the group allocation; all other staff and outcome assessors are blinded.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator Ali Ahıskalıoğlu

Study Record Dates

• First Submitted: November 19, 2025
• First Posted: November 28, 2025
• Study Start: January 1, 2026
• Primary Completion: May 1, 2026
• Study Completion: May 2, 2026
• Last Updated: January 5, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)