Arthroscopic Shoulder Surgery Clinical Trial
Official title:
Randomized Control Trial of Ultrasound-Guided Erector Spinae Block Versus Shoulder Periarticular Anesthetic Infiltration for Pain Control After Arthroscopic Shoulder Surgery
NCT number | NCT03691922 |
Other study ID # | 4668 |
Secondary ID | |
Status | Completed |
Phase | N/A |
First received | |
Last updated | |
Start date | July 6, 2019 |
Est. completion date | February 1, 2021 |
Verified date | August 2020 |
Source | McMaster University |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Arthroscopic shoulder surgery is a common and minimally invasive procedure utilized for different shoulder pathologies, but it is often associated with moderate to severe postoperative pain that may interfere with patients' well-being and course of recovery. By using an effective analgesic technique with few side effects, a patient may experience less pain after surgery, have a shortened hospital stay, and endure less nausea, vomiting, or excessive drowsiness that are associated with the use of opioids to manage postoperative pain. Periarticular infiltration (PAI) with local anesthetic (LA) has been used for shoulder surgery pain management, but the more effective interscalene nerve block (ISNB) is the current gold standard analgesic modality despite risk of significant side effects including diaphragm paralysis and rebound pain. In this study, the investigators want to look at the effectiveness and safety profile of a novel technique for pain management after shoulder surgery that has the potential to provide successful pain relief with minimal risk of side effects. Half of the patients will be randomly selected to receive the novel nerve block called the Erector Spinae Plane (ESP) block while the other half will receive a more standard PAI of local anesthetic to numb the shoulder. Patients' pain intensity and opioid consumption in the post-anesthesia care unit (PACU) as well as during the first 24 hours after surgery will be evaluated. Any complications from the interventions will also be noted. The investigators predict that the ESP block will provide superior analgesia compared to PAI for these shoulder arthroscopy patients.
Status | Completed |
Enrollment | 62 |
Est. completion date | February 1, 2021 |
Est. primary completion date | February 1, 2020 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - elective arthroscopic shoulder joint surgeries admitted for day surgical procedure - an ability to provide informed consent Exclusion Criteria: - not willing - contraindications to spinal injections as per the American Society of Regional Anesthesia and Pain (ASRA) guidelines - known allergy to LA - allergy to all opioid medications - diagnostic shoulder arthroscopic procedures - inability to understand or comprehend in English language - history of daily opioid medication use for the last one month - patients with planned overnight hospital stay |
Country | Name | City | State |
---|---|---|---|
Canada | St. Joseph's Healthcare Hamilton | Hamilton | Ontario |
Lead Sponsor | Collaborator |
---|---|
McMaster University |
Canada,
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* Note: There are 19 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Recovery room resting pain score | Using the patient-reported numeric rating scale (0-10) (0 is no pain and 10 is worst pain imaginable). | At 30 minutes post-admission to recovery room | |
Secondary | Day Surgery Unit resting pain score | Using the patient-reported numeric rating scale (0-10) (0 is no pain and 10 is worst pain imaginable). | At 5 hours post-operatively | |
Secondary | Pain scores with movement | Using the patient-reported numeric rating scale (0-10). (0 is no pain and 10 is worst pain imaginable). Participants will be asked to sit up from lying down position. | At 30 minutes post-admission to recovery room and 5 hours post-operatively | |
Secondary | Opioid usage | All opioids administered in recovery room and day surgery unit will be converted into Morphine Equivalent Units per patient according to accepted standards. | At 2 hours post-operatively and 5 hours post-operatively | |
Secondary | Incidence of moderate to severe postoperative nausea-vomiting | Using a 0-3 scale (0 is none and 3 severe nausea-vomiting) | At 2 hours post-operatively and 5 hours post-operatively | |
Secondary | Incidence of moderate to severe itching | Using a 0-3 scale (0 is none and 3 severe itching) | At 2 hours post-operatively and 5 hours post-operatively | |
Secondary | Incidence of ipsilateral diaphragmatic paralysis | Diagnosed based on the findings in an anterior posterior chest using ultrasound , with the criteria of "a right hemidiaphragm sitting >2 cm higher than its left counterpart or a left hemidiaphragm sitting equal or higher than the right hemidiaphragm". | 30 minutes post-admission to recovery room | |
Secondary | Incidence of respiratory depression | Opioids discontinued by the Acute Pain Service or recovery room nursing due to concerns of respiratory depression by nursing staff. | At 2 hours post-operatively and 5 hours post-operatively | |
Secondary | Incidence of local anesthetic toxicity | Based on clinical symptoms and signs of local anesthetic toxicity as diagnosed by the attending physician. | At 2 hours post-operatively and 5 hours post-operatively | |
Secondary | Sensory blockade | Seven sensory dermatomes corresponding to shoulder and upper arm and their blockade to cold sensation will be noted. The extent of blockade between the two groups will be compared by their median and range. | At 30 minutes post-admission to recovery room | |
Secondary | Patient Satisfaction with Postoperative Analgesia | Using a 7-item Likert scale (1 is extremely satisfied and 7 is extremely dissatisfied) | At 5 hours post-operatively and 24 hours post-operatively |
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