Interscalene Block Versus Anterior Suprascapular Block for Post-Thoracotomy Shoulder Pain

Interscalene Block Versus Anterior Suprascapular Block for Post-Thoracotomy Shoulder Pain: A Randomized Controlled Trial

This study aims to compare the frequency of occurrence of ipsilateral shoulder pain in patients undergoing thoracotomy with ultrasound-guided interscalene block, anterior suprascapular block as adjunct to epidural and epidural block only.

Study Overview

• Status: Recruiting
• Conditions: Shoulder Pain; Thoracotomy; Interscalene Block; Anterior Suprascapular Block
• Intervention / Treatment: Other: Interscalene block; Other: Anterior suprascapular block; Other: Epidural analgesia

Detailed Description

Thoracotomy is one type of surgery associated with challenging pain that needs to be promptly addressed to avoid post-operative respiratory complications and aid in effective postoperative physiotherapy and patient recovery. Epidural analgesia is considered the gold standard for the thoracotomy procedure. Ipsilateral shoulder pain (ISP) following thoracotomy has an incidence ranging from 37% to 85%.

Being so common, this pain needs more attention and proper anticipation, and management. ISP is usually non-responsive to the effects of epidural and paravertebral blocks.

• Study Type: Interventional
• Enrollment (Estimated): 75
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Mai M Elrawas, MD; Phone Number: 00201222177242; Email: mai.elrawas@nci.cu.edu.eg

Study Locations

• Egypt
  • Cairo, Egypt, 12613
    • Recruiting
    • Cairo University
    • Contact: Mai M Elrawas, MD; Phone Number: 00201222177242; Email: mai.elrawas@nci.cu.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age > 18 years and ≤ 65 years old.
• American Society of Anesthesiologists (ASA) physical status II-III.
• Body mass index 18-35 kg/m2.
• Patients who have a confirmed diagnosis of lung cancer and are scheduled for elective open-lung surgery.

Exclusion Criteria:

• Allergy to local anesthetics.
• Known psychiatric or neurologic disorders.
• Alcohol or narcotics abuse.
• Contraindications to thoracic epidural or suprascapular block, or interscalene block, e.g., coagulopathy or local infection.
• Pre-existing shoulder symptoms.
• History of previous thoracotomy.
• Severe restrictive or obstructive pulmonary disease.
• Pre-existing contralateral diaphragmatic paralysis.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group (I); Patients will receive an ultrasound-guided interscalene block.	Other: Interscalene block; Patients will receive an ultrasound-guided interscalene block.
Experimental: Group (S); Patients will receive an ultrasound-guided anterior suprascapular block.	Other: Anterior suprascapular block; Patients will receive an ultrasound-guided anterior suprascapular block.
Active Comparator: Group (E); Patients will not receive regional blocks apart from epidural analgesia.	Other: Epidural analgesia; Patients will not receive regional blocks apart from epidural analgesia.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency of occurrence of ipsilateral shoulder pain	Frequency of occurrence of ipsilateral shoulder pain will be recorded.	72 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Degree of pain	Each patient will be instructed about postoperative pain assessment with the visual analog scale (VAS). VAS (0 represents "no pain" while 10 represents "the worst pain imaginable"). VAS will be recorded after intensive care unit (ICU) admission then every 6 h postoperative for 72 h.	72 hours postoperatively
Mean arterial pressure	Mean arterial pressure will be recorded every 30 minutes and immediately postoperative then every 4 h postoperative for 48 h.	48 hours postoperatively
Heart rate	Heart rate will be recorded every 30 minutes and immediately postoperative then every 4 h postoperative for 48 h.	48 hours postoperatively
Incidence of complications	Incidence of postoperative complications will be recorded.	72 hours postoperatively
Time to first request of rescue analgesia	Rescue analgesia with 5 ml of 0.25% bupivacaine through the epidural catheter (in case of thoracotomy pain). Ketorolac 30 mg I.V. over 50 cc saline for breakthrough shoulder pain (will not exceed 120 mg/day).	72 hours postoperatively
Total number of rescue analgesia	Total number of rescue analgesia will be recorded.	72 hours postoperatively
Peak Expiratory Flow Rate	Peak Expiratory Flow Rate (PEFR) will be recorded as baseline in holding area before premedication and every 6 h postoperative for 72 h when visual analog scale (VAS) is ≤ 3.	72 hours postoperatively
Forced Expiratory Volume in 1 second (FEV1)	Forced Expiratory Volume in 1 second (FEV1) will be recorded preoperative and at day 0, 1, 2 & 3 when visual analog scale (VAS) is ≤ 3.	72 hours postoperatively
Forced vital capacity (FVC)	Forced vital capacity (FVC) will be recorded preoperative and at day 0, 1, 2 & 3 when visual analog scale (VAS) is ≤ 3.	72 hours postoperatively
Forced Expiratory Volume in 1 second (FEV1) / Forced vital capacity (FVC) ratio	Forced Expiratory Volume in 1 second (FEV1) / Forced vital capacity (FVC) ratio will be recorded preoperative and at day 0, 1, 2 & 3 when visual analog scale (VAS) is ≤ 3.	72 hours postoperatively

Collaborators and Investigators

• Sponsor: National Cancer Institute, Egypt

Study record dates

Study Major Dates

• Study Start (Actual): February 21, 2026
• Primary Completion (Estimated): July 30, 2026
• Study Completion (Estimated): July 30, 2026

Study Registration Dates

• First Submitted: February 14, 2026
• First Submitted That Met QC Criteria: February 14, 2026
• First Posted (Actual): February 20, 2026

Study Record Updates

• Last Update Posted (Actual): February 24, 2026
• Last Update Submitted That Met QC Criteria: February 21, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Musculoskeletal Diseases; Joint Diseases; Arthralgia; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Shoulder Pain; Anesthesia and Analgesia; Analgesia; Analgesia, Epidural
• Other Study ID Numbers: AP2512-501-152-202

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The data will be available upon a reasonable request from the corresponding author after the end of study for one year.
• IPD Sharing Time Frame: After the end of study for one year.
• IPD Sharing Access Criteria: The data will be available upon a reasonable request from the corresponding author.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

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