Diaphragm Sparing Effect of Subomohyoid Block With Infraclavicular or Subscapularis Blocks in Comparison With Interscalen Block for Postoperative Analgesia in Shoulder Surgeries
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 87
- 试验地点
- 2
- 主要终点
- Change is being assessed (Diaphragm excursion)
研究概览
简要总结
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.
详细描述
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 .
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 21 Years 至 60 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patient acceptance.
- •ASA I and ASA II.
- •Age 21-60 years old.
- •Both gender.
- •BMI < 35 Kg/m
- •Accepted mental state of the patient.
- •Elective Unilateral upper limb surgeries at the level of the shoulder.
- •Time of surgery less than 2 hours
排除标准
- •- 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
结局指标
主要结局
Change is being assessed (Diaphragm excursion)
时间窗: 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.
Change is being assessed (Diaphragm excursion)
时间窗: 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.
Thickness fraction
时间窗: basal preoperatively, immediately postoperatively in the PACU, and 6 hours postoperatively
The percentage change in thickness between end expiration and peak inspiration. It was calculated as follows: (thickness at peak inspiration - thickness at end expiration/thickness at end expiration) ×100.
次要结局
- 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)
- postoperative complication of the studied groups(24 hours)
- Total pethidine consumption in 24 hours of the studied groups(24 hours)
- postoperative complication of the studied groups(24 hours)
- 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)
研究者
Emad Hamdy Mohamed Morsy
assistant lecturer of anethesia and surgical intensive care
Zagazig University