SPSIPB vs CCB in Arthroscopic Shoulder Surgeries

Comparison of the Effects of Serratus Posterior Superior Intercostal Plane Block Versus Costoclavicular Brachial Plexus Block on Postoperative Pain and Hemidiaphragmatic Paralysis in Arthroscopic Shoulder Surgeries

The aim is to compare the postoperative analgesic and hemidiaphragmatic effects of Serratus Posterior Superior Intercostal Plane Block (SPSIPB) versus CostoClavicular Brachial Plexus Block (CCBPB) in patients undergoing arthroscopic shoulder surgery.

Study Overview

• Status: Completed
• Conditions: Postoperative Pain; Shoulder Arthoscopy
• Intervention / Treatment: Procedure: Serratus posterior superior intercostal plane block; Procedure: Costoclavicular brachial plexus block

Detailed Description

Patients were divided into two randomized groups: Group 1 (SPSIPB group, n=15) and Group 2 (CCBPB 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 Serratus Posterior Superior Intercostal Plane Block (SPSIPB) with 30 mL of 0.25% bupivacaine. Patients in Group 2 will receive Costoclavicular Brachial Plexus Block (CCBPB) with 15 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 IV and 2x50mg Dexketoprofen IV 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 equal to or 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 unilateral elective arthroscopic shoulder surgery under general anesthesia and were American Society of Anesthesiologists (ASA) score 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

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: SPSIPB; SPSIPB will be performed on the ipsilateral side of the patient right after the anesthesia induction with the patients in lateral position.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 the placement of the needle tip with 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; 30 mL of 0.25% bupivacaine
Active Comparator: CCBPB; CCBPB will be performed on the ipsilateral side of the patient right after the anesthesia induction with the patients in supine position. For CCBPB, a high frequency linear transducer of the USG is placed in the medial infraclavicular fossa parallel and next to the clavicle to identify the axillary artery. The transducer is then tilted cephalad to image the brachial plexus and the artery in a perpendicular orientation between the subclavius muscle and the serratus anterior. The needle is advanced in-plane in a lateral-to-medial direction, adjusting the angle to reach the space in between the three cords. 15 mL of 0.25% bupivacaine is administered.	Procedure: Costoclavicular brachial plexus block; 15 mL of 0.25% bupivacaine

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Rating Scale (NRS) Scores	Numerical rating scale is used for pain assessment. The scores of the numerical rating scale changes between 0 to 10 points. 10 points mean "the most severe pain that the patient ever had". 0 point means "there is no pain." Higher scores mean worse outcome.	Postoperative 24 hours
Diaphragmatic Excursion Difference	Ipsilateral diaphragmatic excursions will be measured both preoperatively right before the anesthesia induction, and postoperatively after 30 minutes of emergence from anesthesia (upon reaching 9 points on modified Aldrete scoring). A diaphragmatic excursion change of up to 25% indicates no nerve involvement, a change between 25%-75% indicates partial involvement, and a change exceeding 75% indicates complete involvement of the phrenic nerve.	Preoperatively right before the anesthesia induction, and postoperatively after 30 minutes of emergence from anesthesia (upon reaching 9 points on modified Aldrete scoring)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of Recovery-15 Patient Survey (QoR-15)	The widespread use of minimally invasive interventions to reduce postoperative mortality and morbidity, combined with the implementation of Enhanced Recovery After Surgery (ERAS) protocols, has heightened overall interest in the postoperative recovery period and the importance of outcome evaluation. To address the emerging needs in this field, new tools prioritizing patient satisfaction have been developed alongside traditional scales that measure classical parameters. The Quality of Recovery-15 Patient Survey (QoR-15) stands out as one of the most up-to-date and reliable examples among these tools. The survey is done both preoperatively to record patients' baseline score, and postoperatively at 24th hour. Higher scores mean better quality of recovery after surgery. Mininum and maximum scores can be '0 (zero)' and '150 (one hundred and fifty)' respectively.	Preoperatively and Postoperatively at 24th hour
Total tramadol consumption	Postoperative total opioid need was recorded as "milligram" in unit.	Postoperative 24 hours

Collaborators and Investigators

• Sponsor: Cumhuriyet University
• Investigators: Principal Investigator: OĞUZ GÜNDOĞDU, Sivas Cumhuriyet University School of Medicine, Anesthesiology and Reanimation

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2025
• Primary Completion (Actual): May 25, 2026
• Study Completion (Actual): June 2, 2026

Study Registration Dates

• First Submitted: November 21, 2025
• First Submitted That Met QC Criteria: November 21, 2025
• First Posted (Actual): December 2, 2025

Study Record Updates

• Last Update Posted (Actual): June 3, 2026
• Last Update Submitted That Met QC Criteria: June 2, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: postoperative pain; regional anesthesia; shoulder arthroscopy; serratus posterior superior intercostal plane block; costoclavicular brachial plexus 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: 2025-10/12

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