Shoulder Syndrome Clinical Trial
Official title:
Efficacy of Ultrasound-Guided Erector Spinae Plane Block for Pain Management Following Arthroscopic Shoulder Surgery
Postoperative pain is important following arthroscopic shoulder surgery. Postoperative
effective pain treatment provides early mobilization and shorter hospital stay.Ultrasound
(US)-guided brachial plexus blocks such as interscalen and supraclavicular block are usually
performed. Interscalen brachial plexus block is one of the most preferred techniques among
these.
The US-guided erector spina plane block (ESPB) is a novel interfacial plan block defined by
Forero et al. Local anesthetic injection is administrated into the deep fascia of erector
spinae. ESPB provides thoracic analgesia at T5 level, abdominal analgesia at T7-9 level, and
lumbar analgesia at T10-12, L3 levels. There are a few case reports about the efficacy of
ESPB for acute and chronic shoulder pain. However, there are no randomized clinical studies.
The aim of this study is to evaluate the efficacy of the US-guided ESPB for postoperative
analgesia management after arthroscopic shoulder surgery.
Postoperative pain is an important issue in patients underwent arthroscopic shoulder surgery.
Pain causes a few problems; discomfortable patients, negative outcomes and longer
rehabilitation. Postoperative effective pain treatment provides early mobilization and
shorter hospital stay, thus complications due to hospitalization such as infection and
thromboembolism may be reduced. Various techniques may be used for postoperative pain
treatment. Opioids are one of the most preferred drugs among the analgesic agents. Parenteral
opioids are generally performed for patients after surgery. However opioids have undesirable
adverse events such as nausea, vomiting, itching, sedation and respiratory depression
(opioid-related adverse events).
Various methods may be performed to reduce the use of systemic opioids and for effective pain
treatment following arthroscopic shoulder surgery. Ultrasound (US)-guided brachial plexus
blocks such as interscalen and supraclavicular block are commonly used. Interscalen brachial
plexus block is one of the most preferred techniques among these.
US-guided interfascial plane blocks have been used increasily due to the advantages of
ultrasound in anesthesia practice. The US-guided erector spina plane block (ESPB) is a novel
interfacial plan block defined by Forero et al. at 2016. The ESPB contains a local anesthetic
injection into the deep fascia of erector spinae. This area is away from the pleural and
neurological structures and thus minimizes the risk of complications due to injury.
Visualization of sonoanatomy with US is easy, and the spread of local anesthesic agents can
be easily seen under the erector spinae muscle. Thus, analgesia occurs in several dermatomes
with cephalad-caudad way. Cadaveric studies have shown that the injection spreads to the
ventral and dorsal roots of the spinal nerves. ESPB provides thoracic analgesia at T5 level,
abdominal analgesia at T7-9 level, and lumbar analgesia at T10-12, L3 levels. To the best of
our knowledge, there have been a few case reports about the efficacy of ESPB for acute and
chronic shoulder pain. There are no randomized clinical studies, yet.
The aim of this study is to evaluate the efficacy of the US-guided ESPB for postoperative
analgesia management after arthroscopic shoulder surgery. The primary aim is to compare
perioperative and postoperative opioid consumption and the secondary aim is to evaluate
postoperative pain scores (VAS), adverse effects related with opioids (allergic reaction,
nausea, vomiting).
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