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

Not Applicable

Completed

• Conditions: Preoperative; Ultrasound; Thoracic Erector Spinae Plane Block; Costoclavicular Block; Shoulder Arthroscopy
• Interventions: Drug: Erector Spinae plane Block; Drug: Costoclavicular block; Drug: Control group

• Registration Number: NCT06913140
• Lead Sponsor: Tanta University

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

Study Timeline

• Study Start: 2022-12-01
• Primary Completion: 2024-11-01
• Study Completion: 2024-11-01
• Study First Submitted: 2025-03-29
• Study First Submitted QC: 2025-03-29
• Status Verified: 2025-04
• Study First Posted: 2025-04-06
• Last Update Submitted: 2025-04-22
• Last Update Posted: 2025-04-25

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 90

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

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Erector Spinae plane Block group	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)
Costoclavicular block group	Costoclavicular block	Patients received (20ml) plain bupivacaine 0.25% injected in the costoclavicular space lateral to axillary artery
Control group	Control group	Patients received sham block .

Primary Outcome Measures

Name	Time	Method
Total Pethidine consumption	24 hours postoperatively	Each patient was instructed about postoperative pain assessment with the Visual Analogue Scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable") at (T 30 min, 2, 4, 6,12, 18, 24 h, non-steroidal anti-inflammatory drugs were given (ketorolac 30mg) to all patient /8 h and if VAS \> 4 intravenous pethidine 0.5 mg / kg per dose.

Secondary Outcome Measures

Name	Time	Method
Time to first analgesic request after surgery	24 hours postoperatively	Time to 1st request for the rescue of analgesia (time from the end of surgery till first dose of morphine administrated) was recorded.
Degree of pain	24 hours postoperatively	Each patient was instructed about postoperative pain assessment with the Visual Analogue Scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable") at (T 30 min, 2, 4, 6,12, 18, 24 h, non-steroidal anti-inflammatory drugs were given (ketorolac 30mg) to all patient /8 h and if VAS \> 4 intravenous pethidine 0.5 mg / kg per dose.
Complications	24 hours postoperatively	Complications (Hematoma, pneumothorax, persistent numbness/ paraesthesia or motor deficit one week after the surgery) were recorded.

Trial Locations

Locations (1)

Tanta University; 🇪🇬 Tanta, El-Gharbia, Egypt