Comparison of the Effects of Serratus Posterior Superior Intercostal Plane Block Versus Costoclavicular Brachial Plexus Block on Postoperative Pain and Hemidiaphragmatic Paralysis in Arthroscopic Shoulder Surgeries
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 30
- 试验地点
- 1
- 主要终点
- Numeric Rating Scale (NRS) Scores
研究概览
简要总结
The aim is to compare the postoperative analgesic and hemidiaphragmatic effects of Serratus Posterior Superior Intercostal Plane Block (SPSIPB) versus CostoClavicular Brachial Plexus Block (CCBPB) in patients undergoing arthroscopic shoulder surgery.
详细描述
Patients were divided into two randomized groups: Group 1 (SPSIPB group, n=15) and Group 2 (CCBPB group, n=15). All patients will receive the same standard general anesthesia per hospital protocol. All blocks will be applied with the same ultrasonography and block equipment, and by the same physician. Before the anesthesia induction, ipsilateral diaphragmatic excursion will be measured via Ultrasonography (USG). After the anesthesia induction, patients in Group 1 will receive Serratus Posterior Superior Intercostal Plane Block (SPSIPB) with 30 mL of 0.25% bupivacaine. Patients in Group 2 will receive Costoclavicular Brachial Plexus Block (CCBPB) with 15 mL of 0.25% bupivacaine. All patients will receive Paracetamol 1gr and Dexketoprofen 50mg intravenous (IV) 10 minutes prior to skin closure. After 30 minutes of emergence from anesthesia (upon reaching 9 points on modified Aldrete scoring), ipsilateral diaphragmatic excursion will be assessed again. Pre- and postblock excursion differences will be recorded. Routine analgesic procedure consisting of 3x1gr Paracetamol IV and 2x50mg Dexketoprofen IV will be followed postoperatively for 24 hours. Numeric Rating Scale (NRS) will be used to assess postoperative pain on 1st, 6th, 12th, 18th and 24th hours after the surgery. Quality of Recovery-15 Patient Survey will be done both preoperatively for a baseline score, and postoperatively at 24th hour to assess the quality of recovery from the patients' view. Tramadol 50mg IV will be administered as a rescue analgesic for all patients if NRS score is equal to or higher than 4. Total Tramadol consumption will be calculated.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 85 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult patients older than 18 years of age who underwent unilateral elective arthroscopic shoulder surgery under general anesthesia and were American Society of Anesthesiologists (ASA) score I-II-III according to the ASA risk classification.
排除标准
- •patients who did not give consent,
- •patients with coagulopathy,
- •patients with signs of infection at the block application site,
- •patients using anticoagulants,
- •patients with local anesthetic drug allergies,
- •patients with unstable hemodynamics,
- •patients who could not cooperate during postoperative pain assessment
研究组 & 干预措施
SPSIPB
SPSIPB will be performed on the ipsilateral side of the patient right after the anesthesia induction with the patients in lateral position.The ultrasound probe was placed 2-3 cm medial to the scapular spine to visualize the trapezius, rhomboid major, and serratus posterior superior muscles. At the level of the 2nd-3rd ribs, a needle was advanced into the plane between the serratus posterior superior muscle and the ribs. After confirming the placement of the needle tip with negative aspiration, 30 mL of 0.25% bupivacaine was injected. The block was performed unilaterally, targeting the shoulder undergoing surgery.
干预措施: Serratus posterior superior intercostal plane block (Procedure)
CCBPB
CCBPB 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.
干预措施: Costoclavicular brachial plexus block (Procedure)
结局指标
主要结局
Numeric Rating Scale (NRS) Scores
时间窗: Postoperative 24 hours
Numerical rating scale is used for pain assessment. The scores of the numerical rating scale changes between 0 to 10 points. 10 points mean "the most severe pain that the patient ever had". 0 point means "there is no pain." Higher scores mean worse outcome.
Diaphragmatic Excursion Difference
时间窗: Preoperatively right before the anesthesia induction, and postoperatively after 30 minutes of emergence from anesthesia (upon reaching 9 points on modified Aldrete scoring)
Ipsilateral diaphragmatic excursions will be measured both preoperatively right before the anesthesia induction, and postoperatively after 30 minutes of emergence from anesthesia (upon reaching 9 points on modified Aldrete scoring). A diaphragmatic excursion change of up to 25% indicates no nerve involvement, a change between 25%-75% indicates partial involvement, and a change exceeding 75% indicates complete involvement of the phrenic nerve.
次要结局
- Total tramadol consumption(Postoperative 24 hours)
- Quality of Recovery-15 Patient Survey (QoR-15)(Preoperatively and Postoperatively at 24th hour)
研究者
Oguz Gundogdu
Associate Professor
Cumhuriyet University