ISB, SSNB, and PENG Block for Arthroscopic Shoulder Surgery

NCT ID: NCT05739201

Last Updated: 2023-09-06

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 90 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-02-20
• Study Completion Date: 2023-12-20

Brief Summary

This study is designed to investigate the post-operative analgesic effect of interscalene nerve block or anterior suprascapular nerve block compared to pericapsular nerve group block in patient undergoing elective arthroscopic shoulder surgery.

Detailed Description

Shoulder arthroscopy is a common outpatient operation with an increasing number of indications and complexity. Early postoperative pain immediately following shoulder surgery is a major concern and cause of distress for patients and orthopedic surgeons. Adequate pain control is vital for all aspects of the patient's recovery.

Nowadays, several ultrasound -guided regional anesthesia methods are used for postoperative analgesia. Regional techniques such as interscalene and supraclavicular blocks are usually preferred for shoulder analgesia. Interscalene brachial plexus block (ISB) is the gold standard technique in this area.

Suprascapular nerve block (SSB) has been proposed as an alternative to the ISB in providing analgesia for shoulder surgeries as it has a lower likelihood of causing phrenic nerve blockade.

The pericapsular nerve group (PENG) block has been suggested to be safely applied for analgesia and can be part of surgical anesthesia, but alone is not sufficient for anesthesia in shoulder surgery. The block of this area did not cause motor block or pulmonary complications, nor result in muscle laxity, blocking only the shoulder and the upper third of the humerus.

Conditions

Interscalene Nerve Block; Anterior Suprascapular Nerve Block; Arthroscopic Shoulder Surgery

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

Group (I)

30 patients will receive interscalene nerve block.

Group Type: ACTIVE_COMPARATOR

interscalene nerve block

Intervention Type: PROCEDURE

Patients will receive interscalene nerve block, in which the patient will be in supine position with the head turned to the contralateral side using an ultrasound scan to identify the C5 and C6 nerve roots between the scalene muscles.15 ml of 0.25% Bupivacaine will be deposited between the C5 and C6 nerve roots, within the interscalene groove using a 22 gauge-regional block needle.

Group (II)

30 Patients will receive anterior suprascapular nerve block.

Group Type: ACTIVE_COMPARATOR

anterior suprascapular nerve block

Intervention Type: PROCEDURE

Patients will receive anterior suprascapular nerve block, in which the patient will be in supine position with the head turned to the contralateral side, using an ultrasound the nerve will be traced as it diverges from the brachial plexus to lie under the omohyoid muscle in the supraclavicular fossa. 15 ml of 0.25% Bupivacaine will be deposited lateral to the suprascapular nerve, underneath the omohyoid muscle using a 22 gauge-regional block needle.

Group (III)

30 atients will receive pericapsular nerve group block around shoulder surgery

Group Type: ACTIVE_COMPARATOR

Peri-capsular nerve group block

Intervention Type: PROCEDURE

Patients will receive PENG block, in which the patient will be in supine position and the patient's arm will be placed in external rotation and abducted at 45 degrees, using an ultrasound the humeral head, the tendon of the subscapularis muscle and the deltoid muscle over it will be defined, 15 ml of 0.25% Bupivacaine will be placed between the deltoid muscle and subscapularis tendon using a 22 gauge-regional block needle.

Interventions

interscalene nerve block

Patients will receive interscalene nerve block, in which the patient will be in supine position with the head turned to the contralateral side using an ultrasound scan to identify the C5 and C6 nerve roots between the scalene muscles.15 ml of 0.25% Bupivacaine will be deposited between the C5 and C6 nerve roots, within the interscalene groove using a 22 gauge-regional block needle.

Intervention Type: PROCEDURE

anterior suprascapular nerve block

Patients will receive anterior suprascapular nerve block, in which the patient will be in supine position with the head turned to the contralateral side, using an ultrasound the nerve will be traced as it diverges from the brachial plexus to lie under the omohyoid muscle in the supraclavicular fossa. 15 ml of 0.25% Bupivacaine will be deposited lateral to the suprascapular nerve, underneath the omohyoid muscle using a 22 gauge-regional block needle.

Intervention Type: PROCEDURE

Peri-capsular nerve group block

Patients will receive PENG block, in which the patient will be in supine position and the patient's arm will be placed in external rotation and abducted at 45 degrees, using an ultrasound the humeral head, the tendon of the subscapularis muscle and the deltoid muscle over it will be defined, 15 ml of 0.25% Bupivacaine will be placed between the deltoid muscle and subscapularis tendon using a 22 gauge-regional block needle.

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Adult patients.
• ASA class I and II and scheduled for elective shoulder arthroscopy.

Exclusion Criteria

• Patient who refuses the regional anesthesia technique.
• History of allergy to local anesthetics.
• Local infection at the site of the block.
• History of Pre-existing major organ dysfunction such as hepatic and renal failure.
• History of pre-existing lung disease (COPD, uncontrolled asthma).
• Preexisting upper extremity neurological abnormality or neuropathy.
• Difficulties in comprehending (NRS).
• Chronic opioid users (opioid intake more than 3 months).

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Tanta University

OTHER

Sponsor Role: lead

Responsible Party

Shrouk Elsawaf

Resident

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Ayman A Youssef, MD

Role: PRINCIPAL_INVESTIGATOR

Professor of Anaesthesiology, Surgical Intensive Care and Pain Therapy, Faculty of Medicine, Tanta University, Egypt

Locations

Shrouk Mohamed Elsawaf

Tanta, EL-Gharbia, Egypt

Site Status: RECRUITING

Countries

Egypt

Central Contacts

Shrouk M Elsawaf, Master

Role: CONTACT

Shroukms95@gmail.com

+201091533902 ext. +20

Facility Contacts

Shrouk M Elsawaf, Master

Role: primary

Shroukms95@gmail.com

01091533902 ext. +20

Other Identifiers

36264MS18/1/23

Identifier Type: -

Identifier Source: org_study_id