Anterior Suprascapular Versus Interscalene Block for Postoperative Analgesia After Arthroscopic Shoulder Surgery in the Outpatient Setting

NCT07831096 | Recruiting

• 1 other identifier: BISS-DS
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

Shoulder surgery performed in the outpatient setting can be associated with moderate to severe postoperative pain, especially during the first hours after surgery. Regional anesthesia is commonly used to improve postoperative pain control, reduce opioid use, and support early recovery and safe discharge. The interscalene block (ISB) is widely considered an effective regional anesthesia technique for shoulder surgery, but it may be associated with adverse effects such as diaphragmatic impairment, dyspnea, hoarseness, Horner syndrome, and prolonged upper limb motor block. The anterior suprascapular nerve block (SSNB-A) is a more selective regional anesthesia technique that may provide comparable postoperative analgesia with fewer block-related adverse effects. This prospective, randomized, single-blind, noninferiority trial compares SSNB-A with ISB in adult patients undergoing unilateral shoulder surgery in the outpatient setting. All participants receive general anesthesia and the same multimodal analgesic strategy. The primary objective is to determine whether SSNB-A is noninferior to ISB for postoperative pain control, assessed using the Numeric Rating Scale (NRS). Secondary outcomes include quality of recovery measured with the QoR-15 questionnaire, block-related adverse events, sensory and motor block characteristics, and the need for rescue analgesic medication.

Conditions

Postoperative Pain, Acute

Keywords

Shoulder surgery; Interscalene block; Anterior suprascapular nerve block; Regional Anesthesia; Outpatient Surgery; Postoperative analgesia; Quality of recovery; Numeric Rating Scale; Multimodal Analgesia

Outcome Measures

Primary Outcomes (1)

• Postoperative pain intensity at 6 hours after surgery

  Postoperative pain intensity assessed using the Numeric Rating Scale (NRS), where 0 indicates no pain and 10 indicates the worst imaginable pain. The primary analysis compares NRS pain scores between the anterior suprascapular nerve block group and the interscalene block group to assess noninferiority.

  6 hours after surgery

Secondary Outcomes (5)

• Postoperative Pain Intensity at Other Predefined Postoperative Time Points

  At post-anesthesia care unit arrival and at 12, 18, 24, 36, 48, and 72 hours after surgery

• Quality of Recovery

  On postoperative day 0, postoperative day 1, postoperative day 2, postoperative day 3, and postoperative day 5

• Incidence of Block-Related Adverse Events

  From block performance through postoperative day 0

• Rescue Analgesic Consumption

  From post-anesthesia care unit arrival through postoperative day 5

• Sensory and Motor Block Characteristics

  At 30 minutes after block performance, at post-anesthesia care unit arrival, and 6 hours after surgery

Study Arms (2)

Interscalene block

ACTIVE COMPARATOR

Participants randomized to this group receive an ultrasound-guided interscalene brachial plexus block before shoulder surgery, followed by standardized general anesthesia and the same multimodal postoperative analgesic protocol used in both study groups.

Procedure: Interscalene Nerve Block; Drug: Ropivacaine

Anterior Suprascapular Nerve Block

EXPERIMENTAL

Participants randomized to this group receive an ultrasound-guided anterior suprascapular nerve block before shoulder surgery, followed by standardized general anesthesia and the same multimodal postoperative analgesic protocol used in both study groups.

Procedure: Anterior suprascapular nerve block; Drug: Ropivacaine

Interventions

Interscalene Nerve Block PROCEDURE

Participants receive an ultrasound-guided interscalene brachial plexus block before shoulder surgery using 10 mL of ropivacaina 0,5%, followed bu standardized general anesthesia and postoperative multimodal analgesia

Also known as: Ultrasound-guided interscalene block, ISB

Interscalene block

Anterior suprascapular nerve block PROCEDURE

Participants receive an ultrasound-guided anterior suprascapular nerve block before shoulder surgery using 10 mL of ropivacaine 0,5%, followed by standardized general anesthesia and postoperative multimodal analgesia.

Also known as: SSNB-A, Ultrasound-guided anterior suprascapular nerve block

Anterior Suprascapular Nerve Block

Ropivacaine DRUG

Ropivacaine 0.5% is used as the local anesthetic for the assigned ultrasound-guided regional anesthesia procedure. Participants receive 10 mL of ropivacaine 0.5% either for interscalene brachial plexus block or for anterior suprascapular nerve block, according to randomized group allocation. The same drug concentration and volume are used in both study groups.

Also known as: Ropivacaine 0.5%

Anterior Suprascapular Nerve Block; Interscalene block

Eligibility Criteria

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

You may qualify if:

• Age \> 18 years.
• ASA physical status I, II, or III.
• Scheduled for unilateral shoulder orthopedic surgery in the outpatient/day surgery setting under general anesthesia.
• Surgical procedures may include long head of biceps tenotomy, biceps anchor repair, Bankart procedure, rotator cuff repair with or without biological membrane augmentation, subacromial decompression, acromioplasty, or acromioclavicular stabilization.
• Ability to understand the study procedures and provide written informed consent.

You may not qualify if:

• Contraindication to regional anesthesia, including allergy to local anesthetics, infection at the injection site, bleeding diathesis, or other contraindications according to applicable clinical practice recommendations.
• Allergy to paracetamol or to any drug used in the multimodal rescue analgesic strategy.
• Known neuropathy or sensory/motor deficit in the surgical area or in the territory of innervation of the study blocks.
• History of psychiatric or behavioral disorders that may interfere with study participation or outcome assessment.
• Severe obesity, defined as body mass index (BMI) \> 40 kg/m2.
• Severe chronic obstructive pulmonary disease, GOLD stage III-IV.
• Pregnancy.
• Known phrenic nerve palsy associated with diaphragmatic paralysis.
• Chronic opioid use during the previous 3 months.
• Severe chronic pain during the previous 3 months, defined as NRS \> 4.
• Non-adherence to the postoperative analgesic protocol.

Sponsors & Collaborators

• ASST Sette Laghi: lead

Study Sites (1)

University Hospital Varese ASST SetteLaghi

Varese, Italy, 21100, Italy

RECRUITING

Related Publications (4)

• Dogan AT, Cosarcan SK, Gurkan Y, Koyuncu O, Ercelen O, Demirhan M. Comparison of anterior suprascapular nerve block versus interscalane nerve block in terms of diaphragm paralysis in arthroscopic shoulder surgery: a prospective randomized clinical study. Acta Orthop Traumatol Turc. 2022 Nov;56(6):389-394. doi: 10.5152/j.aott.2022.22044.

  PMID: 36567542 BACKGROUND

• Lim YC, Koo ZK, Ho VW, Chang SS, Manohara S, Tong QJ. Randomized, controlled trial comparing respiratory and analgesic effects of interscalene, anterior suprascapular, and posterior suprascapular nerve blocks for arthroscopic shoulder surgery. Korean J Anesthesiol. 2020 Oct;73(5):408-416. doi: 10.4097/kja.20141. Epub 2020 Jul 16.

  PMID: 32668833 BACKGROUND

• White L, Reardon D, Davis K, Velli G, Bright M. Anterior suprascapular nerve block versus interscalene brachial plexus block for arthroscopic shoulder surgery: a systematic review and meta-analysis of randomized controlled trials. J Anesth. 2022 Feb;36(1):17-25. doi: 10.1007/s00540-021-03000-z. Epub 2021 Sep 17.

  PMID: 34533639 BACKGROUND

• Abdallah FW, Wijeysundera DN, Laupacis A, Brull R, Mocon A, Hussain N, Thorpe KE, Chan VWS. Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery: A Multicenter Randomized Trial. Anesthesiology. 2020 Apr;132(4):839-853. doi: 10.1097/ALN.0000000000003132.

  PMID: 32044802 BACKGROUND

MeSH Terms

Conditions

Pain, Postoperative

Interventions

Ropivacaine

Condition Hierarchy (Ancestors)

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

Intervention Hierarchy (Ancestors)

Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines

Central Study Contacts

Giorgio Rossoni, MD

CONTACT

0039 0332393447; giorgio.rossoni@asst-settelaghi.it

Anna Marcato Anna Marcato, MD

CONTACT

0039 0332393447; anna.marcato@asst-settelaghi.it

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: Participants and postoperative outcome assessors are blinded to treatment allocation. The anesthesiologist performing the regional anesthesia technique is not blinded because the two blocks require different anatomical approaches. Postoperative data collection is performed by assessors unaware of grous assignment
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MD

Model Details: Participants are randomized in a 1:1 ratioto receive either ultrasound-guided interscalene block or ultrasound-guided anterior suprascapular nerve block before shoulder surgery. The two groups are followed in parallel and receive the same general anesthesia and multimodal postoperative analgesic protocol.

Study Record Dates

• First Submitted: September 9, 2026
• First Posted: September 21, 2026
• Study Start: January 16, 2026
• Primary Completion (Estimated): February 1, 2027
• Study Completion (Estimated): April 1, 2027
• Last Updated: September 21, 2026

Record last verified: 2026-09

Locations

IT (1)