Anterior Suprascapular Nerve Block is an Effective and Diaphragm Protective Approach for Arthroscopic Shoulder Surgery

Phase 4

Completed

• Conditions: Anterior Suprascapular Nerve Block; Diaphragm Paralysis Due to Local Anesthesia; Analgesia, Arthroscopic Shoulder Surgery

• Registration Number: NCT04626869
• Lead Sponsor: Alper Tunga Dogan

Brief Summary

Interscalene block is still the gold standard in shoulder surgery analgesia. The most important side effect is diaphragm paralysis due to the phrenic nerve being affected. It may cause symptomatic dyspnea, especially in patients with limited respiratory capacity. There are studies showing that an effective analgesia, as much as the interscalene block can do, can be provided by blocking the suprascapular nerve in the neck region.

The aim of our study is to show that the anterior suprascapular block applied with ultra-low volume (5ml) in shoulder arthroscopy operations is at least as effective as the interscalene block and does not cause diaphragm paralysis.

Detailed Description

Interscalene block is still the gold standard in shoulder surgery analgesia. The most important side effect is diaphragm paralysis due to the phrenic nerve being affected. It may cause symptomatic dyspnea, especially in patients with limited respiratory capacity. More distal brachial plexus blocks have been defined to avoid diaphragmatic paralysis . Thus, it is aimed to apply the local anesthetic drug further from the phrenic nerve. With the application of ultrasound, the amount of local anesthetic drug was reduced to less than 20 ml.

There are studies showing that an effective analgesia, as much as the interscalene block can do, can be provided by blocking the suprascapular nerve in the neck region. Although it has been shown in a cadaver study that the phrenic nerve can be stained after anterior suprascapular nerve block, the clinical effect is not fully known.

The effect of continuous local anesthetic drug administration on respiratory muscles through catheters placed in the peripheral nerve is another matter of concern. The method that will not affect the phrenic nerve at all and at the same time provide an effective analgesia is still under investigation.

The aim of our study is to show that the anterior suprascapular block applied with ultra-low volume (5ml) in shoulder arthroscopy operations is at least as effective as the interscalene block and does not cause diaphragm paralysis. One of the questions that our research aims to answer is how the continuous application of local anesthetic drugs affects the diaphragm muscle with the insertion of catheters in both regions.

Study Timeline

• Study First Submitted: 2020-09-16
• Study First Submitted QC: 2020-11-07
• Study First Posted: 2020-11-13
• Study Start: 2020-12-01
• Primary Completion: 2021-03-15
• Study Completion: 2021-04-01
• Status Verified: 2021-11
• Last Update Submitted: 2021-11-28
• Last Update Posted: 2021-11-30

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 50

Inclusion Criteria

• Patients > 18 years old
• American Society of Anesthesiology (ASA) score of 1-3
• Scheduled for elective surgery.

Exclusion Criteria

• Patients with a condition that prevents peripheral nerve block
• Coagulopathies
• Chronic opioid use
• Stroke
• Polyneuropathy
• Cognitive dysfunction
• Communication difficulties
• Allergies to drugs used

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Pain rating	Postoperative 12 hours	Measured by VAS. Postoperative 12 hours

Secondary Outcome Measures

Name	Time	Method
Diaphragmatic movements	At the first postoperative 24 hours	Diaphragmatic movement will be evaluated with ultrasound. 24 hours after the block application.

Trial Locations

Locations (1)

VKV Amerikan Hastanesi; 🇹🇷 Istanbul, Sisli, Turkey