Diaphragm Sparing Effect of Subomohyoid Block With Infraclavicular or Subscapularis Blocks in Comparison With Interscalen Block for Postoperative Analgesia in Shoulder Surgeries
- Conditions
- Shoulder Surgeries Operations
- Interventions
- Procedure: diaghragm affection by ultrasound before and after the blocks
- Registration Number
- NCT05920421
- Lead Sponsor
- Zagazig University
- Brief Summary
The gold standard for shoulder analgesia is the interscalene block (ISB), but it has its own share of disadvantages such as phrenic nerve block, recurrent laryngeal nerve involvement and Horner's syndrome may lead to patient discomfort .Others, such as intrathecal spread and systemic toxicity of local anesthetic, can have serious consequences.
Phrenic nerve injury is a common complication with regional anesthesia. Its either temporary with Transient Phrenic Nerve Palsy leading to hemidiaphragmatic paresis after interscalene block or other injections of local anesthetic in the neck .
Although studies of ISB have shown a reduction in the incidence in hemidiaphragmatic paralysis with low-volume ISB, the risk of phrenic paralysis is not completely eliminated.
To bypass this complication, distal block of the shoulder innervation is recommended such as subomohyoid infraclavicular and subomohyoid subscapularis blocks.
- Detailed Description
Ultrasound has a significant role in recent anesthesia. It plays a significant role in detecting diaphragmatic mobility and detecting phrenic nerve palsy after regional anesthesia . the common and standard technique for shoulder analgesia is interscalen block. but it has its own complications like phrenic nerve palsy.
to bypass this complications ,several ways had been tried to overcome this complications.
in this study, the investigator compare between the standard interscalen block with distal blocks like infraclavicular subomohyoid block and subomohyoid subscapularis blocks according to diaghragm affection , duration of analgesia , side effects occured with blocks.
For infraclavicular subomohyoid block, the infraclavicular approach targets the posterior and lateral cords, thus anesthetizing the axillary nerve (which supplies the anterior and posterior shoulder joint), whereas the suprascapular nerve block done by blocking subomohyoid muscle anesthetizes the posterior shoulder.
For subscapularis subomohyoid block, subscapularis is done before subomohyoid block. Subscapularis block target subscapular nerve which arise from posterior cord and present on ventral surface of subscapularis muscle .
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 69
- Patient acceptance.
- ASA I and ASA II.
- Age 21-60 years old.
- Both gender.
- BMI < 35 Kg/m2.
- Accepted mental state of the patient.
- Elective Unilateral upper limb surgeries at the level of the shoulder.
- Time of surgery less than 2 hours
-
- Patient refusal.
- Peripheral neuropathy.
- Pathological coagulopathy.
- Infection at the injection site.
- Untreated pneumothorax.
- Disturbed conscious level.
- An allergy to local anesthetics used in this study
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description interscalen group diaghragm affection by ultrasound before and after the blocks (29) patients will receive interscalene block before induction of general anethesia. patients will receive 30 ml of bupivacaine 0.25 %+250 mg of magnesium sulphate. subomohyoid subscapularis group diaghragm affection by ultrasound before and after the blocks (29) patients will receive subomohyoid subscapularis block before induction of general anethesia . patients will receive 30 ml of bupivacaine0.25 %+250 mg of magnesium sulphate. subomohyoid infracavicular group diaghragm affection by ultrasound before and after the blocks (29) patients will receive subomohyoid infraclavicular block before induction of general anethesia. patients will receive 30 m lof bupivacaine 0.25 %+250 mg of magnesium sulphate.
- Primary Outcome Measures
Name Time Method Change is being assessed (Diaphragm excursion) basal preoperatively , immediately postoperatively in the pacu and 6 hours postoperatively As shown before diaphragm excursion will be examined preoperative as basal measurement, immediately postoperative in the PACU and 6 hours postoperatively to detect diaghragm excursion.If ratio of post to pre-block is \< 25% this means that phrenic nerve block is included.
- Secondary Outcome Measures
Name Time Method Visual Analogue Scale (VAS) at different intervals within and between the studied groups immediately postoperative in the PACU , 6 hours postoperatively up to 24 hour postoperatively Time between onset of sensory block to the first report of postoperative pain at the surgical site by visual analogue scale score. the investigators ask patient to estimate degree of pain on scale from 1-10 and ask patient to report degree of pain from 0 to 10 with 0 no pain to 10 worst pain and the investigator will give analgesic requirement once vas \>3 which will be the first analgesic requirement by the patient.
postoperative complication of the studied groups 24 hours the investigator will record patients with complications from the blocks like hypoxemia with saturation \<90% , bradycardia with heart rate \<50, nausea and vomiting
Onset time of sensory block 30 minutes after local anesthetic injection Time between injection of local anesthetics mixture and loss of pin prick sensation in the median, radial, ulnar and musculocutaneous nerve distributions, pin prick test done with sterile 25G needle
Duration of analgesia and total pethidine consumption in 24 hours of the studied groups 24 hours time between onset of sensory block to first recorded pain will be represented as duration of analgesia and the investigator will calculate total amount of pethidine consumed over 24 hours.
Trial Locations
- Locations (1)
Emad Hamdy Mohamed Morsy
🇪🇬Zagazig, Sharqia, Egypt