Anterior and Posterior Approaches of Suprascapular Nerve Block

Comparison of Anterior and Posterior Approaches of Suprascapular Nerve Block in Arthroscopic Shoulder Surgery

Suprascapular nerve is a mixed motor and sensory peripheral nerve arising from the superior trunk of brachial plexus.The suprascapular nerve runs through the posterior triangle of the neck, anterior of the trapezius muscle and dorsal of the omohyoid muscle, in direction of the scapula. Suprascapular nerve block is performed by anterior and posterior approach. Posterior approach of the suprascapular nerve block has been shown for many years to provide effective analgesia in the shoulder region for the chronic and acute pain. There are studies showing that suprascapular block with anterior approach provides effective analgesia in shoulder arthroscopy.

The aim of our study was to compare anterior and posterior approaches of suprascapular nerve block in terms of analgesic efficacy and patient safety.

Study Overview

• Status: Completed
• Conditions: Postoperative Pain; Shoulder Pain; Diaphragmatic Paralysis; Suprascapular Nerve Block; Subomohyoid Suprascapular Nerve Block; Anterior Suprascapular Nerve Block
• Intervention / Treatment: Procedure: Posterior suprascapular block; Procedure: Anterior suprascapular block

Detailed Description

This study is a prospective randomized clinical trial will be conducted between March 2022 and March 2023.Participant will divide into two groups as participant who underwent suprascapular nerve block with the anterior approach and participant who underwent suprascapular nerve block with the posterior approach. Bupivacaine 5 ml %0.5 will be injected both group. Diaphragmatic thickness fraction will be evaluated with ultrasound left and right 7.-8. subcostal anterior axillary border with the participant with the semi-sitting position. Diaphragmatic thickness fraction will measure before the block and after 30 minutes the surgery. Participants will administered intravenous morphine patient controlled analgesia for 24 hours stay. The amount of opioid analgesics given in both groups will be determined (in mg). Postoperative 4th, 6th, 12th, 24th hour Visual Analogue Scale scores of the participants and opioid consumptions until that hours will be evaluated. An addition participant will be determined according to the surgery.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey, 34722
    • İstanbul medeniyet University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 78 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patient who accepts to study protocol
• Scheduled for shoulder surgery
• Between the ages of 18 and 80

Exclusion Criteria:

• Patients with coagulopathy
• Patients with a history of local anesthetic drug allergy and toxicity
• Patients with advanced organ failure
• Patients with mental retardation
• Patients with infection present at the injection site
• Patients with diaphragm paralysis
• Pregnant patients

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Posterior suprascapular block; Suprascapular block performed by posterior approach	Procedure: Posterior suprascapular block; Diaphragmatic thickness fraction will be evaluated in the participant underwent suprascapular block performed by posterior approach
Active Comparator: Anterior suprascapular block; Suprascapular block performed by anterior approach	Procedure: Anterior suprascapular block; Diaphragmatic thickness fraction will be evaluated in the participant underwent suprascapular block performed by anterior approach

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative pain at the first postoperatively 30th. Min.	Visual analog scale (1-10): 1= no pain, 10= the worst pain ever feel.	The first postoperative 30 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Diaphragmatic movements	Ratio of diaphragm thickness in end-inspiration and end-expiration measured by ultrasonography	Baseline (Before the block performed) and 30 minutes after the end of surgery
Postoperative opioid analgesic consumption (morphine)	milligram	postoperative 4 hours
Postoperative opioid analgesic consumption (morphine)	milligram	postoperative 6 hours
Postoperative opioid analgesic consumption (morphine)	milligram	postoperative 12 hours
Postoperative opioid analgesic consumption (morphine)	milligram	postoperative 24 hours
Peroperatively opioid analgesic consumption (Remifentanil)	milligram	postoperative 0th.min
Postoperative opioid analgesic consumption (morphine)	milligram	postoperative 30th. Min
Postoperative pain at postoperative 4th. Hours	Visual analog scale (1-10): 1= no pain, 10= the worst pain ever feel.	at postoperative 4th. Hours
Postoperative pain at postoperative 6th. Hours	Visual analog scale (1-10): 1= no pain, 10= the worst pain ever feel.	at postoperative 6th. Hours
Postoperative pain at postoperative 12th. Hours	Visual analog scale (1-10): 1= no pain, 10= the worst pain ever feel.	at postoperative 12th. Hours
Postoperative pain at postoperative 24th. Hours	Visual analog scale (1-10): 1= no pain, 10= the worst pain ever feel.	at postoperative 24th. Hours

Collaborators and Investigators

• Sponsor: Istanbul Medeniyet University
• Investigators: Principal Investigator: Ebru Girgin Dinç, MD, İstanbul medeniyet University

Study record dates

Study Major Dates

• Study Start (Actual): March 15, 2022
• Primary Completion (Actual): March 15, 2023
• Study Completion (Actual): March 15, 2023

Study Registration Dates

• First Submitted: April 18, 2022
• First Submitted That Met QC Criteria: July 1, 2022
• First Posted (Actual): July 5, 2022

Study Record Updates

• Last Update Posted (Estimated): March 6, 2024
• Last Update Submitted That Met QC Criteria: March 3, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: Nerve Block; Postoperative pain; Shoulder pain; Diaphragmatic paralysis; Suprascapular block; Subomohyoid suprascapular block; Posterior Suprascapular block; Anterior Suprascapular block
• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Respiratory Tract Diseases; Respiration Disorders; Postoperative Complications; Pain; Neurologic Manifestations; Joint Diseases; Musculoskeletal Diseases; Arthralgia; Respiratory Insufficiency; Pain, Postoperative; Shoulder Pain; Paralysis; Respiratory Paralysis
• Other Study ID Numbers: EDinc

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: After the article is accepted by the journal
• IPD Sharing Time Frame: After the article is accepted by the journal
• IPD Sharing Access Criteria: After the article is accepted by the journal
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No