Efficacy of the C8 Nerve Root Block During Interscalene Block for Anesthesia of the Posterior Aspect of the Shoulder
- Conditions
- Brachial Plexus BlockShoulder Pain
- Interventions
- Procedure: Conventional interscalene blockProcedure: Interscalene block with C8 root block
- Registration Number
- NCT03487874
- Lead Sponsor
- Daegu Catholic University Medical Center
- Brief Summary
This study evaluates the effects of selective 8th cervical nerve root block during interscalene brachial plexus block on the relief of pain intensity upon the introduction of a posterior portal during arthroscopic shoulder surgery. The 5th to 7th cervical nerve roots will be blocked in half of participants, while the 5th to 8th cervical nerve roots will be blocked in the other half.
- Detailed Description
By blocking only the 5th to 7th cervical nerve blocks, conventional interscalene brachial plexus block spares the 8th cervical and 1st thoracic dermatomes which innervate the posterior aspect of the shoulder. To visualize the shoulder joint space during shoulder arthroscopic surgery, the introduction of a posterior portal is essential. However, conventional interscalene brachial plexus block cannot effectively relieve the pain caused by its insertion due to sparing of the 8th cervical and 1st thoracic dermatomes. The addition of the 8th cervical nerve root block to conventional interscalene brachial plexus block decreases pain intensity upon the introduction of a posterior portal.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 74
- American Society of Anesthesiologists physical status 1 and 2
- Arthroscopic shoulder surgery under interscalene brachial plexus block
- Patient refusal
- Contralateral hemidiaphragmatic paralysis or paresis
- Contralateral vocal cord palsy
- Severe pulmonary restrictive disease
- Coagulopathy
- Allergy to local anesthetics or history of allergic shock
- Difficulty communicating with medical personnel
- Peripheral neuropathy or neurologic sequelae on the operative limb
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Interscalene block with C8 root block 0.75% ropivacaine The 5th to 8th cervical nerve root block under ultrasound guidance using 25 to 30 ml of 0.75% ropivacaine Conventional interscalene block Conventional interscalene block The 5th to 7th cervical nerve root block under ultrasound guidance using 25 to 30 ml of 0.75% ropivacaine Interscalene block with C8 root block Interscalene block with C8 root block The 5th to 8th cervical nerve root block under ultrasound guidance using 25 to 30 ml of 0.75% ropivacaine Conventional interscalene block 0.75% ropivacaine The 5th to 7th cervical nerve root block under ultrasound guidance using 25 to 30 ml of 0.75% ropivacaine
- Primary Outcome Measures
Name Time Method Pain intensity upon the introduction of a posterior portal 50 minutes after interscalene block 0, 1, and 2 represent no pain, mild pain, and severe pain, respectively.
- Secondary Outcome Measures
Name Time Method Frequency of postoperative analgesic use 24 hours Frequency of analgesic use during 24 hours after surgery
Motor blockade 30 minutes after interscalene block Motor blockade of the radial, ulnar, median, musculocutaneous, and axillary nerves graded from 0 to 2 (0 = complete block, 1 = partial block, and 2 = no block)
Pulmonary function test Before interscalene block and 30 minutes after interscalene block Forced expiratory volume at one second (FEV1) and FEV1/forced vital capacity before and 30 minutes after the end of local anesthetic injection
Complications related with interscalene block 24 hours Presence or absence of vascular puncture, local anesthetic systemic toxicity, pneumothorax, and paresthesia
Postoperative hour when pain starts to be felt 24 hours Time at regression of anesthesia which starts to cause postoperative pain during 24 hours after surgery
Patient's satisfaction about surgical anesthesia and postoperative analgesia 24 hours Likert scale consisting of "very dissatisfied", "dissatisfied", "unsure", "satisfied", and "very satisfied"
Sensory blockade 30 minutes after interscalene block C5 to T1 dermatomal blockade graded from 0 to 2 (0 = no cold sensation, 1 = reduced cold sensation, and 2 = normal cold sensation) by applying ice to the shoulder
Ipsilateral hemidiaphragmatic blockade Before interscalene block and 30 minutes after interscalene block Extent of a reduction in the amplitude of excursion of the diaphragm on the vertical axis of the M-mode wave under M-mode ultrasound evaluation
Horner's syndrome Before interscalene block and 30 minutes after interscalene block The extent of a reduction in the ipsilateral pupil size measured by a pupillometer Presence or absence of ptosis
Dose of postoperative analgesic use 24 hours Cumulative dose of analgesic required for postoperative analgesia during 24 hours after surgery
Conversion into general anesthesia 1 hour Number of patients whose regional anesthesia is converted into general anesthesia due to incomplete surgical anesthesia provided by the regional anesthesia
Numerical pain rating score between 6 and 12 hours after surgery 6 and 12 hours Numerical pain rating score ranging from 0 to 10 (0 = no pain, 10 = worst pain imaginable) between 6 and 12 hours after surgery
Worst numerical pain rating score 24 hours Worst numerical pain rating score ranging from 0 to 10 (0 = no pain, 10 = worst pain imaginable) during 24 hours after surgery
Dose of intraoperative analgesic use 2 hours Cumulative dose of analgesic to supplement incomplete surgical anesthesia
Numerical pain rating score at admission to postanesthetic care unit 5 minutes Numerical pain rating score ranging from 0 to 10 (0 = no pain, 10 = worst pain imaginable) at admission to postanesthetic care unit
Numerical pain rating score at discharge from postanesthetic care unit 30 minutes Numerical pain rating score ranging from 0 to 10 (0 = no pain, 10 = worst pain imaginable) at discharge from postanesthetic care unit
Numerical pain rating score 24 hours after surgery 24 hours Numerical pain rating score ranging from 0 to 10 (0 = no pain, 10 = worst pain imaginable) 24 hours after surgery
Frequency of intraoperative analgesic use 2 hours Frequency of analgesic use to supplement incomplete surgical anesthesia
Trial Locations
- Locations (1)
Daegu Catholic University Medical Center
🇰🇷Daegu, Korea, Republic of