Postoperative Analgesia of Magnesium Sulfate in Suprascapular Nerve Block Following Shoulder Arthroscopy
- Conditions
- Arthroscopic Shoulder Surgery
- Interventions
- Drug: Bupivacaine-magnesiumDevice: Ultrasound
- Registration Number
- NCT03602469
- Lead Sponsor
- Mansoura University
- Brief Summary
* Arthroscopic shoulder surgeries in adults are accompanied with severe immediate postoperative pain reported in approximately 45% of patients. For quicker recovery and rehabilitation of these patients, postoperative analgesia is mandatory.
* Different analgesic modalities have been proposed including parenteral opioids, intra-articular injection of local anesthetics, interscalene brachial plexus block (ISB), and a suprascapular nerve block (SSNB), with varying degrees of effectiveness and multiple reported side effects.
* A recent meta-analysis demonstrates that suprascapular block results in 24-h morphine consumption and pain scores similar to ISB, so, it may be considered an effective and safe alternative for interscalene block in shoulder surgery, with less motor restriction, and fewer complications.
* Different agents are used as adjuvants to local anesthetics during peripheral nerve block to prolong its analgesic action including magnesium sulfate.
* A meta-analysis by Mengzhu et al., concluded that magnesium sulfate combined with local anesthetics in perineural nerve blocks provided better analgesic efficacy and may be a promising analgesic for perineural nerve blocks.
* Antinociceptive effects of magnesium are due to the regulation of calcium influx into the cell and a non-competitive antagonism of the NMDA receptors
- Detailed Description
The aim of this study is to evaluate the effects of magnesium sulfate as an adjuvant to bupivacaine in suprascapular nerve block on the duration and quality of postoperative analgesia following shoulder arthroscopy, postoperative pain VAS scores, intraoperative fentanyl requirements, sedation scores, respiratory depression, postoperative 24 hours cumulative morphine consumption.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 60
- ASA physical status I-III
- Patient's refusal
- Significant cardiac diseases
- Significant hepatic diseases
- Significant renal diseases (serum creatinine ˃ 1.5 mg/dl)
- Cardiac conduction abnormalities
- Drug abuse
- Pregnancy
- Allergy to study medications
- Mental disease
- Communication barrier
- Coagulopathy
- Local skin infection
- Traumatic nerve injury of upper limb
- Patients receiving opioid analgesics
- Patients receiving magnesium sulfate
- Patients receiving beta blockers
- Patients receiving calcium channel blockers
- Previous shoulder surgery
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Bupivacaine-magnesium Bupivacaine-magnesium Ultrasound-guided suprascapular nerve block using bupivacaine in conjunction of magnesium sulfate will be performed before induction of general anesthesia Bupivacaine Ultrasound Ultrasound-guided suprascapular nerve block using bupivacaine will be performed before induction of general anesthesia Bupivacaine-magnesium Ultrasound Ultrasound-guided suprascapular nerve block using bupivacaine in conjunction of magnesium sulfate will be performed before induction of general anesthesia Bupivacaine Rocuronium Ultrasound-guided suprascapular nerve block using bupivacaine will be performed before induction of general anesthesia Bupivacaine Bupivacaine Ultrasound-guided suprascapular nerve block using bupivacaine will be performed before induction of general anesthesia Bupivacaine Propofol Ultrasound-guided suprascapular nerve block using bupivacaine will be performed before induction of general anesthesia Bupivacaine Sevoflurane Ultrasound-guided suprascapular nerve block using bupivacaine will be performed before induction of general anesthesia Bupivacaine-magnesium Propofol Ultrasound-guided suprascapular nerve block using bupivacaine in conjunction of magnesium sulfate will be performed before induction of general anesthesia Bupivacaine-magnesium Sevoflurane Ultrasound-guided suprascapular nerve block using bupivacaine in conjunction of magnesium sulfate will be performed before induction of general anesthesia Bupivacaine-magnesium Rocuronium Ultrasound-guided suprascapular nerve block using bupivacaine in conjunction of magnesium sulfate will be performed before induction of general anesthesia
- Primary Outcome Measures
Name Time Method Duration of postoperative analgesia For 8 hours after suprascapular nerve block time from administering the study solution in the suprascapular block till the time for the first rescue morphine request
- Secondary Outcome Measures
Name Time Method Postoperative cumulative morphine consumption For 24 hours after surgery Number of antiemetics received For 24 hours after surgery Intraoperative fentanyl requirements For 5 hours after suprascapular nerve block Systolic arterial blood pressure At baseline, immediately after induction of anaesthesia, at skin incision, every 15 minutes till the end of surgery, on arrival to PACU, then at 30, 60 minutes after surgery , every 6 hours up to 24 hours postoperatively Number of vomiting episodes For 24 hours after surgery Pain score at rest time 0 (after extubating) and at 30 minutes, 1 hour , 2 hours, 4hours, 6hours, 8hours,12 hours , 16hours, 20 hours and 24 hours postoperatively Pain score as assessed using visual analogue scale to assess the severity of postoperative pain (0 mm for no pain and 100 mm for worst imaginable pain)
Pain score on shoulder abduction time 0 (after extubating) and at 30 minutes, 1 hour , 2 hours, 4hours, 6hours, 8hours,12 hours , 16hours, 20 hours and 24 hours postoperatively Pain score as assessed using visual analogue scale to assess the severity of postoperative pain (0 mm for no pain and 100 mm for worst imaginable pain)
Diastolic arterial blood pressure At baseline, immediately after induction of anaesthesia, at skin incision, every 15 minutes till the end of surgery, on arrival to PACU, then at 30, 60 minutes after surgery , every 6 hours up to 24 hours postoperatively Heart rate At baseline, immediately after induction of anaesthesia, at skin incision, every 15 minutes till the end of surgery, on arrival to PACU, then at 30, 60 minutes after surgery ,every 6 hours up to 24 hours postoperatively The degree of nausea and vomiting For 24 hours after surgery Nausea will be measured using a numerical rating system (none= 0; mild= 1; moderate= 2; severe= 3)
Sedation scores at 1 hour, 2 hours, and 6 hours postoperatively Sedation: will be assessed using a sedation scale (awake and alert= 0; quietly awake= 1; asleep but easily roused= 2; deep asleep= 3).
Trial Locations
- Locations (1)
Mansoura University
🇪🇬Mansourah, DK, Egypt