Comparison of the Effects of Combined Anterior Suprascapular Nerve Block and Infraclavicular Brachial Plexus Block Versus Costoclavicular Brachial Plexus Block on Postoperative Pain and Hemidiaphragmatic Paralysis in Shoulder Arthroscopy

For this group, ASSNB and ICBPB blocks will be performed on the ipsilateral side of the patient right after the anesthesia induction with the patients in supine position. For ICBPB, a high frequency linear transducer USG is placed over the lateral infraclavicular fossa in a sagittal orientation medial to the coracoid process and caudal to the clavicle. The block needle is inserted in-plane from a cephalad-to-caudal direction, just inferior to the clavicle to pass through the pectoralis major and minor muscles, aiming toward the posterior aspect of the axillary artery. 15 mL of 0.25% bupivacaine is administered. For ASSNB, the transducer is positioned in a sagittal oblique orientation over the supraclavicular fossa to image the subclavian artery and the brachial plexus. While tracing the plexus craniocaudally, the suprascapular nerve is identified. The needle is advanced in-plane from posterior to anterior. 10 mL of 0.25% bupivacaine is administered.

For this group, ASSNB and ICBPB blocks will be performed on the ipsilateral side of the patient right after the anesthesia induction with the patients in supine position. For ICBPB, a high frequency linear transducer USG is placed over the lateral infraclavicular fossa in a sagittal orientation medial to the coracoid process and caudal to the clavicle. The block needle is inserted in-plane from a cephalad-to-caudal direction, just inferior to the clavicle to pass through the pectoralis major and minor muscles, aiming toward the posterior aspect of the axillary artery. 15 mL of 0.25% bupivacaine is administered. For ASSNB, the transducer is positioned in a sagittal oblique orientation over the supraclavicular fossa to image the subclavian artery and the brachial plexus. While tracing the plexus craniocaudally, the suprascapular nerve is identified. The needle is advanced in-plane from posterior to anterior. 10 mL of 0.25% bupivacaine is administered.

For this group, CCBPC will be performed on the ipsilateral side of the patient right after the anesthesia induction with the patients in supine position. For CCBPB, a high frequency linear transducer of the USG is placed in the medial infraclavicular fossa parallel and next to the clavicle to identify the axillary artery. The transducer is then tilted cephalad to image the brachial plexus and the artery in a perpendicular orientation between the subclavius muscle and the serratus anterior. The needle is advanced in-plane in a lateral-to-medial direction, adjusting the angle to reach the space in between the three cords. 15 mL of 0.25% bupivacaine is administered.