ISB, SSNB, and PENG Block for Arthroscopic Shoulder Surgery

Comparative Study Between Interscalene Nerve Block, Anterior Suprascapular Nerve Block, and Pericapsular Nerve Group Block for Arthroscopic Shoulder Surgery

This study is designed to investigate the post-operative analgesic effect of interscalene nerve block or anterior suprascapular nerve block compared to pericapsular nerve group block in patient undergoing elective arthroscopic shoulder surgery.

Study Overview

• Status: Recruiting
• Conditions: Arthroscopic Shoulder Surgery; Anterior Suprascapular Nerve Block; Interscalene Nerve Block
• Intervention / Treatment: Procedure: interscalene nerve block; Procedure: anterior suprascapular nerve block; Procedure: Peri-capsular nerve group block

Detailed Description

Shoulder arthroscopy is a common outpatient operation with an increasing number of indications and complexity. Early postoperative pain immediately following shoulder surgery is a major concern and cause of distress for patients and orthopedic surgeons. Adequate pain control is vital for all aspects of the patient's recovery.

Nowadays, several ultrasound -guided regional anesthesia methods are used for postoperative analgesia. Regional techniques such as interscalene and supraclavicular blocks are usually preferred for shoulder analgesia. Interscalene brachial plexus block (ISB) is the gold standard technique in this area.

Suprascapular nerve block (SSB) has been proposed as an alternative to the ISB in providing analgesia for shoulder surgeries as it has a lower likelihood of causing phrenic nerve blockade.

The pericapsular nerve group (PENG) block has been suggested to be safely applied for analgesia and can be part of surgical anesthesia, but alone is not sufficient for anesthesia in shoulder surgery. The block of this area did not cause motor block or pulmonary complications, nor result in muscle laxity, blocking only the shoulder and the upper third of the humerus.

• Study Type: Interventional
• Enrollment (Estimated): 90
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Shrouk M Elsawaf, Master; Phone Number: +20 +201091533902; Email: Shroukms95@gmail.com

Study Locations

• Egypt
  • EL-Gharbia
    • Tanta, EL-Gharbia, Egypt, 31527
      • Recruiting
      • Shrouk Mohamed Elsawaf
      • Contact: Shrouk M Elsawaf, Master; Phone Number: +20 01091533902; Email: Shroukms95@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adult patients.
• ASA class I and II and scheduled for elective shoulder arthroscopy.

Exclusion Criteria:

• Patient who refuses the regional anesthesia technique.
• History of allergy to local anesthetics.
• Local infection at the site of the block.
• History of Pre-existing major organ dysfunction such as hepatic and renal failure.
• History of pre-existing lung disease (COPD, uncontrolled asthma).
• Preexisting upper extremity neurological abnormality or neuropathy.
• Difficulties in comprehending (NRS).
• Chronic opioid users (opioid intake more than 3 months).

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group (I); 30 patients will receive interscalene nerve block.	Procedure: interscalene nerve block; Patients will receive interscalene nerve block, in which the patient will be in supine position with the head turned to the contralateral side using an ultrasound scan to identify the C5 and C6 nerve roots between the scalene muscles.15 ml of 0.25% Bupivacaine will be deposited between the C5 and C6 nerve roots, within the interscalene groove using a 22 gauge-regional block needle.
Active Comparator: Group (II); 30 Patients will receive anterior suprascapular nerve block.	Procedure: anterior suprascapular nerve block; Patients will receive anterior suprascapular nerve block, in which the patient will be in supine position with the head turned to the contralateral side, using an ultrasound the nerve will be traced as it diverges from the brachial plexus to lie under the omohyoid muscle in the supraclavicular fossa. 15 ml of 0.25% Bupivacaine will be deposited lateral to the suprascapular nerve, underneath the omohyoid muscle using a 22 gauge-regional block needle.
Active Comparator: Group (III); 30 atients will receive pericapsular nerve group block around shoulder surgery	Procedure: Peri-capsular nerve group block; Patients will receive PENG block, in which the patient will be in supine position and the patient's arm will be placed in external rotation and abducted at 45 degrees, using an ultrasound the humeral head, the tendon of the subscapularis muscle and the deltoid muscle over it will be defined, 15 ml of 0.25% Bupivacaine will be placed between the deltoid muscle and subscapularis tendon using a 22 gauge-regional block needle.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
the total opioid consumption.	Postoperative analgesia will be assessed by total opioid consumption and time till administration of first rescue analgesia will be recorded.	24-hour postoperatively

Collaborators and Investigators

• Sponsor: Tanta University
• Investigators: Principal Investigator: Ayman A Youssef, MD, Professor of Anaesthesiology, Surgical Intensive Care and Pain Therapy, Faculty of Medicine, Tanta University, Egypt

Study record dates

Study Major Dates

• Study Start (Actual): February 20, 2023
• Primary Completion (Estimated): December 20, 2023
• Study Completion (Estimated): December 20, 2023

Study Registration Dates

• First Submitted: February 13, 2023
• First Submitted That Met QC Criteria: February 13, 2023
• First Posted (Actual): February 22, 2023

Study Record Updates

• Last Update Posted (Actual): September 6, 2023
• Last Update Submitted That Met QC Criteria: September 2, 2023
• Last Verified: September 1, 2023

More Information

Terms related to this study

• Other Study ID Numbers: 36264MS18/1/23

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The data will be available upon reasonable request from the principal investigator
• IPD Sharing Time Frame: one year
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No