Comparison of SPSIPB With SSB and ICB Combination in Arthroscopic Shoulder Surgeries

November 14, 2025 updated by: Oguz Gundogdu, Cumhuriyet University

Comparison of Serratus Posterior Superior Intercostal Plane Block With Combination of Suprascapular and Infraclavicular Nerve Blocks in Postoperative Analgesia Management in Arthroscopic Shoulder Surgery

The aim to compare postoperative analgesic requirements between patients undergoing arthroscopic shoulder surgery who received either the SSB-ICB combination or SPSIPB, and to determine whether one technique has superiority over the other.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

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Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Patients were divided into two randomized groups: Group 1 (SSB+ICB combination group, n=15) and Group 2 (SPSIPB 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 anterior suprascapular nerve block (SSB) with 10 mL of 0.25% bupivacaine and infraclavicular brachial plexus block (ICB) with 15 mL of 0.25% bupivacaine (with a total volume of 25 mL). Patients in Group 2 will receive serratus posterior superior intercostal plane block (SPSIPB) with 30 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 and 2x50mg Dexketoprofen 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 higher than 4. Total Tramadol consumption will be calculated.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
30

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
    • Sivas
      • Sivas, Sivas, Turkey (Türkiye), 58140
        • Sivas Cumhuriyet University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adult patients older than 18 years of age who underwent arthroscopic shoulder surgery under general anesthesia and were American Society of Anesthesiologists (ASA) I-II-III according to the ASA risk classification.

Exclusion Criteria:

  • 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
  • patients diagnosed with frozen shoulder

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Active Comparator: Combination of SSB and ICB
Immediately after anesthesia induction, anterior suprascapular nerve block (SSB) and infraclavicular brachial plexus block (ICB) will be performed on the ipsilateral side with the patient supine. For ICB, a high-frequency linear ultrasound probe is placed sagittally over the lateral infraclavicular fossa, medial to the coracoid process and caudal to the clavicle. The needle is inserted below the clavicle, directed cephalad-to-caudal through the pectoralis major and minor toward the posterior aspect of the axillary artery, and 15 mL of 0.25% bupivacaine is injected. For SSB, the probe is positioned over the supraclavicular fossa in a sagittal oblique plane to visualize the subclavian artery and brachial plexus. The suprascapular nerve is identified beneath the omohyoid muscle, the needle is advanced in-plane from lateral to medial, and 10 mL of 0.25% bupivacaine is administered.
Procedure: suprascapular nerve block

Suprascapular nerve block (SSB): 10ml of 0.25% bupivacaine was injected around the suprascapular nerve beneath the omohyoid muscle.

Infraclavikular nerve block(ICB): The needle is inserted below the clavicle, directed cephalad-to-caudal through the pectoralis major and minor toward the posterior aspect of the axillary artery, and 15 mL of 0.25% bupivacaine is injected
Active Comparator: SPSIPB
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 negative aspiration, 30 mL of 0.25% bupivacaine was injected. The block was performed unilaterally, targeting the shoulder undergoing surgery.
Procedure: Serratus posterior superior intercostal plane block
Serratus posterior superior intercostal plane block (SPSIPB): 30 ml of 0.25% bupivacaine was injected into the plane between the serratus posterior superior muscle and the ribs.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Numeric Rating Scale (NRS)
Time Frame: 24 hours after surgery
Numeric Rating Scale (NRS): The patient selects a number between 0, representing "no pain," and 10 or 100, representing "unbearable pain." This method is highly sensitive and is one of the most commonly used pain scoring tools.
24 hours after surgery
Total tramadol consumption
Time Frame: 24 hours after surgery
Total postoperative analgesic (tramadol) requirement was recorded in the unit as "milligrams".
24 hours after surgery

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Diaphragm Excursion Difference
Time Frame: Preoperatively, immediately before anesthesia induction, and postoperatively, 30 minutes after emergence from anesthesia (when a modified Aldrete score of 9 is reached)
Ipsilateral diaphragmatic movement will be assessed both immediately before anesthesia induction in the preoperative period and 30 minutes after emergence from anesthesia (when a modified Aldrete score of 9 is reached). A change of up to 25% in diaphragmatic movement indicates no nerve involvement, a change between 25% and 75% indicates partial involvement, and a change exceeding 75% indicates complete phrenic nerve blockade.
Preoperatively, immediately before anesthesia induction, and postoperatively, 30 minutes after emergence from anesthesia (when a modified Aldrete score of 9 is reached)
Quality of Recovery-15 Patient Questionnaire (QoR-15)
Time Frame: 24th hour after surgery
The widespread use of minimally invasive procedures to reduce postoperative morbidity and mortality, combined with the implementation of Enhanced Recovery After Surgery (ERAS) protocols, has increased overall interest in the postoperative recovery period and the assessment of outcomes. To address emerging needs in this field, new tools prioritizing patient satisfaction have been developed alongside traditional scales that measure classic parameters. Among these, the Quality of Recovery-15 (QoR-15) patient questionnaire stands out as one of the most up-to-date and reliable instruments. The questionnaire is administered both preoperatively, to record the patient's baseline, and 24 hours after surgery. Higher scores indicate better postoperative recovery quality, with possible scores ranging from 0 to 150.
24th hour after surgery

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Cumhuriyet University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

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Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
February 15, 2024

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
November 20, 2024

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 20, 2024

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
November 14, 2025

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 14, 2025

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
November 18, 2025

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
November 18, 2025

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 14, 2025

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
October 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 2024-01/07

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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