SPENG Block Versus Suprascapular and Axillary Nerve Blocks for Pain After Shoulder Arthroscopy

NCT07762417 | Not Yet Recruiting

• 1 other identifier: SPENG-RCT-2026-01
• Study Type: interventional
• Target: 60
• Locations: 0 countries
• Sites: N/A

Brief Summary

This prospective, randomized, patient- and assessor-blinded, single-center non-inferiority trial will compare the analgesic efficacy of the Shoulder Posterior Pericapsular Nerve Group (SPENG) block with combined posterior suprascapular and axillary nerve blocks in adults undergoing elective shoulder arthroscopy under general anesthesia. Both groups will receive the same total volume and concentration of local anesthetic. The primary outcome will be the highest resting Numeric Rating Scale pain score recorded during the first 24 postoperative hours. Secondary outcomes will include block performance time, sensory block success in suprascapular and axillary nerve territories, opioid consumption, time to rescue analgesia, motor function, diaphragmatic function, postoperative recovery quality, patient satisfaction, and block-related complications.

Conditions

Postoperative Pain; Shoulder Arthroscopy

Keywords

Diaphragm-sparing block; Postoperative analgesia; Regional anesthesia; Axillary nerve block; Suprascapular nerve block; Shoulder arthroscopy; Shoulder Posterior Pericapsular Nerve Group block; SPENG block

Outcome Measures

Primary Outcomes (1)

• Highest Resting Numeric Rating Scale Pain Score During the First 24 Postoperative Hours

  Resting postoperative pain intensity will be assessed using an 11-point Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). For each participant, the highest resting NRS score recorded during the first 24 postoperative hours will be used as the primary outcome. Scheduled assessments will be performed on arrival in the post-anesthesia care unit and at 4, 8, 12, and 24 hours after surgery. Resting NRS scores obtained immediately before rescue analgesic administration outside these scheduled assessments will also be included when determining the highest value.

  From arrival in the post-anesthesia care unit through 24 hours after surgery

Secondary Outcomes (15)

• Block Performance Time

  Periprocedural

• Proportion of Participants With Complete Dual-Target Sensory Block Success

  30 minutes after block completion

• Cumulative Opioid Consumption During the First 24 Postoperative Hours

  From arrival in the post-anesthesia care unit through 24 hours after surgery

• Time to First Rescue Analgesic

  From block completion through 24 hours after surgery

• Resting Numeric Rating Scale Pain Scores

  On arrival in the post-anesthesia care unit and at 4, 8, 12, and 24 hours after surgery

Study Arms (2)

SPENG Block

EXPERIMENTAL

Participants assigned to this group will receive an ultrasound-guided Shoulder Posterior Pericapsular Nerve Group (SPENG) block before general anesthesia for shoulder arthroscopy. A total of 20 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be administered as a single injection between the posterior glenoid rim and the deep surface of the infraspinatus muscle.

Procedure: Shoulder Posterior Pericapsular Nerve Group (SPENG) Block

Posterior Suprascapular and Axillary Nerve Blocks

ACTIVE COMPARATOR

Participants assigned to this group will receive ultrasound-guided posterior suprascapular and axillary nerve blocks before general anesthesia for shoulder arthroscopy. A total of 20 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be administered, consisting of 10 mL for the posterior suprascapular nerve block and 10 mL for the axillary nerve block.

Procedure: Combined Posterior Suprascapular and Axillary Nerve Blocks

Interventions

Shoulder Posterior Pericapsular Nerve Group (SPENG) Block PROCEDURE

An ultrasound-guided single-injection posterior pericapsular block. With the participant in the lateral decubitus position and the operative shoulder uppermost, a high-frequency linear ultrasound transducer will be placed transversely immediately inferior to the posterior acromion. After identification of the humeral head, articular cartilage, infraspinatus muscle, and posterior glenoid rim, a block needle will be advanced in-plane in a medial-to-lateral direction. The needle tip will be positioned between the posterior glenoid rim and the deep surface of the infraspinatus muscle, and 20 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be injected.

Also known as: SPENG Block

SPENG Block

Combined Posterior Suprascapular and Axillary Nerve Blocks PROCEDURE

wo ultrasound-guided nerve blocks will be performed. For the posterior suprascapular nerve block, the suprascapular nerve will be identified in the suprascapular notch region beneath the supraspinatus muscle, and 10 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be administered. For the axillary nerve block, the posterior humeral circumflex artery will be identified using color Doppler in the quadrilateral space, and 10 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be administered adjacent to the axillary nerve.

Also known as: Posterior Shoulder Block

Posterior Suprascapular and Axillary Nerve Blocks

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 to 70 years
• American Society of Anesthesiologists (ASA) physical status I-III
• Scheduled to undergo elective shoulder arthroscopy under general anesthesia
• Able to understand the Numeric Rating Scale for pain assessment
• Able and willing to provide written informed consent

You may not qualify if:

• Known allergy or hypersensitivity to local anesthetics used in the study
• Infection at the planned block injection site
• Coagulopathy or ongoing anticoagulant therapy that cannot be appropriately interrupted for peripheral nerve block
• Pre-existing neurological deficit affecting the operative upper extremity
• Moderate or severe pulmonary disease
• Known diaphragmatic dysfunction
• Chronic opioid use
• Chronic pain syndrome
• Body mass index greater than 35 kg/m²
• Pregnancy or breastfeeding
• Inability to understand or reliably report Numeric Rating Scale pain scores
• Inadequate sonographic window preventing safe performance of the allocated block technique before randomization

Sponsors & Collaborators

• Izmir City Hospital: lead

MeSH Terms

Conditions

Pain, Postoperative

Interventions

Dental Occlusion

Condition Hierarchy (Ancestors)

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

Intervention Hierarchy (Ancestors)

Dentistry; Dental Physiological Phenomena; Digestive System and Oral Physiological Phenomena

Study Officials

• Murat KAYKAC, MD

  Izmir City Hospital

  PRINCIPAL INVESTIGATOR

• Derya ARSLAN YURTLU, Professor

  Izmir City Hospital

  STUDY DIRECTOR

Central Study Contacts

Murat KAYKAC, MD

CONTACT

+905330258450; drmuratkaykac@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: Participants and outcome assessors will be blinded to treatment allocation. Before block placement, participants will receive intravenous midazolam. Both groups will be positioned similarly, and identical dressings will be applied over the posterior shoulder and suprascapular regions after block completion to conceal the injection sites. Outcome assessments will be performed by an investigator who is not involved in block administration and is unaware of treatment allocation. The physician performing the block cannot be blinded because of the procedural differences between the interventions and will not participate in outcome assessment.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Anesthesiology and Reanimation Specialist

Model Details: Participants will be randomly assigned in a 1:1 ratio to receive either a single-injection Shoulder Posterior Pericapsular Nerve Group (SPENG) block or combined posterior suprascapular and axillary nerve blocks before elective shoulder arthroscopy. Both groups will receive the same total volume, concentration, and dose of local anesthetic.

Study Record Dates

• First Submitted: August 9, 2026
• First Posted: August 13, 2026
• Study Start (Estimated): November 1, 2026
• Primary Completion (Estimated): May 31, 2027
• Study Completion (Estimated): June 15, 2027
• Last Updated: August 14, 2026

Record last verified: 2026-08

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ANALYTIC CODE
• Time Frame: Beginning after publication of the primary study results and available for 5 years thereafter.
• Access Criteria: Requests from qualified researchers with a scientifically sound proposal will be considered by the principal investigator. Data will be provided in de-identified form for approved research purposes and subject to applicable institutional and ethical requirements.