Interscalene Block Clinical Trial
Official title:
Respiratory and Analgesic Effects of Interscalene Block Versus Pericapsular Nerve Block and Superficial Cervical Plexus Block for Arthroscopic Shoulder Surgery
Interscalene brachial plexus block (ISB) is considered the standard nerve block for shoulder surgery . It provides superior analgesia and reduced opioid-related adverse effects . However, it is challenging to perform and may be associated with a high incidence of ipsilateral hemidiaphragmatic paresis, resulting from a phrenic nerve block . Although that complication could be decreased with modified local anesthetic dosing and ultrasound-guided needle placement , its incidence significantly impair the mechanics of breathing leading to postoperative morbidity, making that block undesirable in patients with impaired pulmonary functions . This clinical problem has recently received considerable attention, with several calls to seek alternatives to interscalene block in shoulder arthroscopy [18]. So, the need for a safer ISB alternative has prompted researchers to examine several options, including but not limited to the suprascapular [19] and pericapsular nerve blocks . Pericapsular nerve block has been studied extensively in hip surgeries , and some physicians suggested that it can be safely applied for analgesia and can be part of surgical anesthesia in shoulder arthroscopic surgery. It induces blockade of the articular branches that innervate the glenohumeral joint . The block of this area does not cause motor block or pulmonary complications, nor result in muscle laxity, blocking only the shoulder and the upper third of the humerus . The cervical plexus is formed by the ventral rami of C1-C4 cervical roots. It can be blocked at the superficial, intermediate and at the deep level [24]. The superficial cervical plexus block results in anesthesia of skin over the anterolateral neck, skin overlying the clavicle and the sternoclavicular joint, anterior and retroauricular areas . Although that block is effective in pain management after surgeries involving the distal clavicle, it has been poorly described in shoulder arthroscopy.
Status | Not yet recruiting |
Enrollment | 42 |
Est. completion date | September 25, 2023 |
Est. primary completion date | September 25, 2023 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 18 Years to 65 Years |
Eligibility | Inclusion Criteria: - Adult patients aged between 18 and 65 years, Classification as class I or II according to the American Society of Anesthesiologists (ASA) , Patients scheduled for elective arthroscopic shoulder procedures. Exclusion Criteria: - • Age beyond the previous limits. - Refusal to participate in the study. - Patients with peripheral neuropathy. - Patients with chronic chest diseases affecting their pulmonary function results. - ASA class > II. - Bleeding diathesis. - Pregnancy. - Recent history of anticoagulant or antiplatelet drug intake. - Cutaneous infection at the injection site. - Patients with pacemakers. - Patients with AV block. - Known allergy to local anesthetics. |
Country | Name | City | State |
---|---|---|---|
Egypt | Tanta University Hospitals | Tanta | ELgharbiaa |
Lead Sponsor | Collaborator |
---|---|
Tanta University |
Egypt,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | • The incidence of postoperative diaphragmatic paralysis | The same diaphragmatic ultrasound measurements will be performed at PACU 30 minutes postoperative then 24 hours after the operation | 24 hour | |
Secondary | • Postoperative pain will be assessed via the NRS, and its values will be recorded at PACU and then at, 2, 4, 6, 12, 18, 24 hour after arthroscopy. | • Postoperative pain will be assessed via the NRS, and its values will be recorded at PACU and then at, 2, 4, 6, 12, 18, 24 hour after arthroscopy. | 24 hour | |
Secondary | The total amount of analgesia and 1st rescue analgesia | • The duration till the first breakthrough pain and the total morphine consumption will be recorded. | 24 hour |
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