Evaluation of the Effects of Combined Infraclavicular Brachial Plexus Block and Suprascapular Nerve Block on the Diaphragm in Arthroscopic Shoulder Surgery
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 61
- 试验地点
- 1
研究概览
简要总结
This prospective observational study was conducted to evaluate the effects of a combined infraclavicular brachial plexus block and anterior suprascapular nerve block on diaphragmatic function in patients undergoing arthroscopic shoulder surgery. A total of 61 adult patients were enrolled in the study. Diaphragmatic excursion was assessed using ultrasonography both prior to block administration and 30 minutes following the procedure during normal and deep breathing. The primary objective was to assess changes in diaphragmatic excursion and determine the incidence of hemidiaphragmatic paralysis associated with this combined block technique. Secondary outcomes included block performance time, duration of postoperative analgesia, the need for additional intraoperative sedation or analgesia, the occurrence of adverse events, and levels of patient and surgeon satisfaction. The study sought to determine whether this regional anesthesia approach could provide effective anesthesia and analgesia while minimizing impairment of diaphragmatic function.
详细描述
This prospective observational study was conducted to evaluate the effects of combined infraclavicular brachial plexus block and anterior suprascapular nerve block on diaphragmatic excursion in patients undergoing elective arthroscopic shoulder surgery.
Patients scheduled for arthroscopic shoulder surgery under regional anesthesia were enrolled in the study. Prior to block administration, baseline diaphragmatic excursion was assessed using ultrasonography during both normal and deep breathing. Each measurement was repeated three times, and the mean value was recorded. The same measurements were repeated 30 minutes after completion of the block procedures using an identical protocol.
The percentage change in diaphragmatic excursion between baseline and post-block measurements was calculated for both normal and deep breathing. Hemidiaphragmatic paralysis was categorized according to the degree of reduction in diaphragmatic excursion as absent (≤25% reduction), partial (25.1-74.9% reduction), or complete (≥75% reduction).
All nerve blocks were performed under ultrasound guidance by anesthesiologists experienced in regional anesthesia techniques. The infraclavicular brachial plexus block was performed using 15 mL of 0.5% bupivacaine deposited around the posterior cord and 8 mL of 0.5% bupivacaine around the lateral cord. The anterior suprascapular nerve block was performed with 7 mL of 0.5% bupivacaine. In addition, arthroscopic portal sites were infiltrated with 10 mL of 0.2% bupivacaine to provide supplementary analgesia.
All patients received intravenous midazolam (2 mg) and paracetamol (1 g) during the intraoperative period. Additional analgesic or sedative medication was administered when required according to clinical conditions and surgical needs. Block performance time, requirement for supplemental analgesia or sedation, and any block-related adverse events were recorded.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients aged 18-80 years.
- •ASA physical status I-III.
- •Scheduled for elective arthroscopic shoulder surgery.
- •Ability to provide written informed consent
排除标准
- •Refusal to undergo peripheral nerve block.
- •Pre-existing peripheral neuropathy.
- •Known pulmonary, hepatic, or renal disease.
- •Allergy to local anesthetics.
- •Infection at the block site.
- •Pre-existing neurological deficit.
- •Body mass index (BMI) > 40 kg/m².
- •Coagulopathy.
- •Previous surgery at the planned block site.
- •Major psychiatric disorders.
- •Inability to complete diaphragmatic ultrasonographic assessment.
研究者
Ceren Gul AKPINAR
Anesthesiology Resident
Gazi University