Preoperative Ultrasound Guided Thoracic Erector Spinae Plane Block Versus Costoclavicular Block for Shoulder Arthroscopy

NCT ID: NCT06913140

Last Updated: 2025-04-25

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 90 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-12-01
• Study Completion Date: 2024-11-01

Brief Summary

This study was conducted to compare the perioperative analgesic effect of ultrasound guided high thoracic erector spinae plane block versus ultrasound guided costoclavicular block for shoulder arthroscopy

Detailed Description

Shoulder surgery is one of the most common orthopedic surgical procedures that causes severe pain . Pain management in such patients is very important because pain relief allows early mobilization, effective postoperative rehabilitation, and shorter hospitalization stays. Several regional anesthesia techniques have been used for pain management following shoulder surgery. Interscalene brachial plexus block (ISB) is the gold standard analgesic technique for shoulder procedures, but this method can lead to some serious complications, such as hemidiaphragmatic paralysis (HDP), Horner's syndrome, and hoarseness.

The costoclavicular block (CCB) was introduced as infraclavicular approach, first described in 2015 , targets the brachial plexus in the costoclavicular space where its three cords are tightly clustered together lateral to the axillary artery and more superficially than with the classical approach of infraclavicular fossa . Recently, Garcia-Vittoria et al have suggested that the costoclavicular space could also serve as a retrograde channel to supraclavicular brachial plexus blocks, so if local anesthetic (LA) injected in the costoclavicular space can reliably reach the supraclavicular brachial plexus enabling reliable anesthesia including anesthesia to the suprascapular nerve during shoulder surgery, one could achieve analgesic parity with small-volume supraclavicular block (and ISB) while retaining the 0% incidence of HDP seen with infraclavicular blocks.

Erector spinae plane block (ESPB) is a relatively novel block and was first described for chronic thoracic neuropathic pain in 2016 (. It is an interfascial plane block, but it may be classified as a paraspinal block due to its mechanism of action and injection site

Conditions

Preoperative; Ultrasound; Thoracic Erector Spinae Plane Block; Costoclavicular Block; Shoulder Arthroscopy

Study Design

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

Study Groups

Erector Spinae plane Block group

Patients received (20ml) plain bupivacaine 0.25% injected beneath the erector spinae muscle sheath at the level of the second thoracic segment (T2)

Group Type: EXPERIMENTAL

Erector Spinae plane Block

Intervention Type: DRUG

Patients received (20ml) plain bupivacaine 0.25% injected beneath the erector spinae muscle sheath at the level of the second thoracic segment (T2)

Costoclavicular block group

Patients received (20ml) plain bupivacaine 0.25% injected in the costoclavicular space lateral to axillary artery

Group Type: EXPERIMENTAL

Costoclavicular block

Intervention Type: DRUG

Patients received (20ml) plain bupivacaine 0.25% injected in the costoclavicular space lateral to axillary artery.

Control group

Patients received sham block .

Group Type: SHAM_COMPARATOR

Control group

Intervention Type: DRUG

Patients received sham block

Interventions

Erector Spinae plane Block

Patients received (20ml) plain bupivacaine 0.25% injected beneath the erector spinae muscle sheath at the level of the second thoracic segment (T2)

Intervention Type: DRUG

Costoclavicular block

Patients received (20ml) plain bupivacaine 0.25% injected in the costoclavicular space lateral to axillary artery.

Intervention Type: DRUG

Control group

Patients received sham block

Intervention Type: DRUG

Other Intervention Names

Bupivacaine 0.25%; Bupivacaine 0.25%; Sham block

Eligibility Criteria

Inclusion Criteria

• 90 patients admitted for elective unilateral shoulder arthroscopy.
• Aged (21 - 65) years.
• American Society of Anesthesiologists (ASA) physical activity I, II

Exclusion Criteria

• Patient refusal.
• Patient with neurological deficit.
• Patient with bleeding disorders (coagulopathy, thrombocytopenia anticoagulant and antiplatelets drugs).
• Uncooperative patient.
• Infection at the block injection site.
• Patients with history of allergy to local anaesthetics

• Minimum Eligible Age: 21 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Tanta University

OTHER

Sponsor Role: lead

Responsible Party

Mohamed Gamal Naeem

Assistant Lecturer of Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Tanta University

Tanta, El-Gharbia, Egypt

Countries

Egypt

Other Identifiers

35844/9/22

Identifier Type: -

Identifier Source: org_study_id