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

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: Completed
• Conditions: Shoulder Arthroscopic Surgery; Pain After Shoulder Surgery
• Intervention / Treatment: Procedure: suprascapular nerve block; Procedure: Serratus posterior superior intercostal plane block

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: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

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

Participation Criteria

Eligibility Criteria

• 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

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
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

Outcome Measure	Measure Description	Time Frame
Numeric Rating Scale (NRS)	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	Total postoperative analgesic (tramadol) requirement was recorded in the unit as "milligrams".	24 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Diaphragm Excursion Difference	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)	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

• Sponsor: Cumhuriyet University

Publications and helpful links

General Publications

• Auyong DB, Hanson NA, Joseph RS, Schmidt BE, Slee AE, Yuan SC. Comparison of Anterior Suprascapular, Supraclavicular, and Interscalene Nerve Block Approaches for Major Outpatient Arthroscopic Shoulder Surgery: A Randomized, Double-blind, Noninferiority Trial. Anesthesiology. 2018 Jul;129(1):47-57. doi: 10.1097/ALN.0000000000002208.
• Tulgar S, Ciftci B, Ahiskalioglu A, Bilal B, Sakul BU, Korkmaz AO, Bozkurt NN, De Cassai A, Torres AJ, Elsharkawy H, Alici HA. Serratus Posterior Superior Intercostal Plane Block: A Technical Report on the Description of a Novel Periparavertebral Block for Thoracic Pain. Cureus. 2023 Feb 3;15(2):e34582. doi: 10.7759/cureus.34582. eCollection 2023 Feb.

Study record dates

Study Major Dates

• Study Start (Actual): February 15, 2024
• Primary Completion (Actual): November 20, 2024
• Study Completion (Actual): December 20, 2024

Study Registration Dates

• First Submitted: November 14, 2025
• First Submitted That Met QC Criteria: November 14, 2025
• First Posted (Actual): November 18, 2025

Study Record Updates

• Last Update Posted (Actual): November 18, 2025
• Last Update Submitted That Met QC Criteria: November 14, 2025
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: postoperative pain; suprascapular nerve block; arthroscopic shoulder surgery; infraclavicular nerve block; Serratus posterior superior intercostal plane block
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative
• Other Study ID 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