Comparison of the Effectiveness of USG-Guided Interscalene Block Versus Combined Interscalen-Suprascapular Block for Arthroscopic Shoulder Surgery (ISB vs SSB)

Comparison of the Effectiveness of Ultrasound-Guided Interscalene Block Versus Combined Interscalene and Suprascapular Nerve Blocks in Arthroscopic Shoulder Surgery

This study aims to compare two commonly used regional anesthesia techniques for shoulder arthroscopy: the ultrasound-guided interscalene block and the combined interscalene-suprascapular nerve block. Both techniques are routinely performed to reduce pain during and after shoulder surgery. The purpose of this study is to determine which method provides better postoperative pain control, reduces the need for pain medication, and causes fewer side effects such as diaphragmatic dysfunction. Participants will receive one of the two nerve block techniques before surgery, and their pain scores, opioid consumption, and respiratory effects will be monitored during the first 24 hours after the operation.

Study Overview

• Status: Not yet recruiting
• Conditions: Postoperative Pain; Shoulder Pain; Artroscopic Surgery
• Intervention / Treatment: Procedure: Ultrasound-Guided Interscalene Block; Procedure: Combined Ultrasound-Guided Interscalene and Suprascapular Nerve Blocks

Detailed Description

Arthroscopic shoulder surgery is a commonly performed procedure, and effective perioperative analgesia is essential for improving patient comfort, reducing opioid consumption, and enabling early rehabilitation. The ultrasound-guided interscalene block is considered the standard regional anesthesia technique for shoulder surgery; however, it may cause hemidiaphragmatic paresis due to phrenic nerve involvement. To reduce this risk while maintaining effective analgesia, the combination of interscalene and suprascapular nerve blocks has recently gained attention as a promising alternative.

The suprascapular nerve supplies approximately 70% of sensory innervation to the shoulder joint, and its blockade may enhance postoperative pain control when combined with a low-volume interscalene block. This combined technique has been proposed as a potentially safer option with fewer respiratory side effects, particularly in patients at risk of reduced pulmonary reserve.

This prospective, randomized clinical study aims to compare the analgesic efficacy and respiratory effects of the ultrasound-guided interscalene block versus the combined interscalene-suprascapular nerve block in patients undergoing arthroscopic shoulder surgery. Participants will be assigned to one of the two block techniques prior to surgery. Standardized anesthesia and postoperative care protocols will be applied. Primary outcomes include postoperative pain scores and opioid consumption during the first 24 hours. Secondary outcomes include diaphragm excursion measurements, block-related complications, patient satisfaction, and recovery profiles.

The results of this study are expected to contribute to determining whether the combined technique provides comparable or superior analgesia with fewer respiratory side effects, potentially offering a safer alternative to traditional interscalene block for shoulder surgery.

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

Contacts and Locations

• Study Contact: Name: Asuman ocaklar, MD, Anesthesiologist; Phone Number: +90 5442013991; Email: asuman-kcygt@hotmail.com
• Study Contact Backup: Name: asuman Ocaklar, MD, Anesthesiologist; Phone Number: +90 5375909724; Email: canocaklar@hotmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

Planned arthroscopic shoulder surgery ASA physical status I-III Age between 18 and 75 years Ability to provide informed consent Suitable for regional anesthesia with ultrasound guidance

Exclusion Criteria:

Allergy or contraindication to local anesthetics Coagulopathy or current anticoagulant therapy Infection at the block injection site Severe pulmonary disease (e.g., severe COPD) Pre-existing neurological deficit in the operative upper limb Body mass index > 40 kg/m² Pregnancy or breastfeeding History of phrenic nerve palsy Inability to cooperate with block procedure or follow-up

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Interscalene Block (ISB); Participants in this arm will receive an ultrasound-guided interscalene brachial plexus block. The block will be performed at the level of the C5-C6 nerve roots using a high-frequency linear ultrasound probe. A local anesthetic solution will be injected around the brachial plexus under real-time ultrasound visualization. This intervention represents the standard regional anesthesia technique used for arthroscopic shoulder surgery.	Procedure: Ultrasound-Guided Interscalene Block; An ultrasound-guided interscalene brachial plexus block performed at the C5-C6 level using a high-frequency linear ultrasound probe. Local anesthetic is injected around the brachial plexus under real-time ultrasound visualization. This technique represents the standard regional anesthesia method for arthroscopic shoulder surgery.
Experimental: ISB+ Suprascapular Block ( ISB+ SSNB); Participants in this arm will receive a combined regional anesthesia technique consisting of an ultrasound-guided interscalene block followed by an ultrasound-guided suprascapular nerve block. The interscalene block will be performed at the C5-C6 level using a high-frequency linear probe. The suprascapular nerve block will be administered at the suprascapular notch under ultrasound visualization. Local anesthetic will be injected around both the brachial plexus and the suprascapular nerve. This combined technique is intended to enhance postoperative analgesia while potentially reducing phrenic nerve involvement compared with the interscalene block alone	Procedure: Combined Ultrasound-Guided Interscalene and Suprascapular Nerve Blocks; A combined regional anesthesia technique consisting of an ultrasound-guided interscalene block performed at the C5-C6 level, followed by an ultrasound-guided suprascapular nerve block administered at the suprascapular notch. Local anesthetic is injected around both the brachial plexus and the suprascapular nerve under ultrasound guidance. This technique aims to improve postoperative analgesia while potentially reducing phrenic nerve involvement.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative Pain Score (VAS 0-24 Hours)	Postoperative pain intensity will be assessed using a standard 0-10 Visual Analog Scale (VAS), where 0 indicates no pain and 10 indicates the worst imaginable pain. Pain scores will be recorded at predefined postoperative time points (e.g., 1, 2, 6, 12, and 24 hours). The primary outcome will be the comparison of cumulative VAS scores between the interscalene block group and the combined interscalene-suprascapular block group during the first 24 postoperative hours.	0-24 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Postoperative Opioid Consumption (0-24 Hours)	Total postoperative opioid consumption will be recorded during the first 24 hours after surgery. All opioid medications will be converted to intravenous morphine milligram equivalents (MME) for standardized comparison between groups. The cumulative opioid requirement of the interscalene block group will be compared with that of the combined interscalene-suprascapular block group.	0-24 hours after surgery

Collaborators and Investigators

• Sponsor: Asuman Ocaklar

Study record dates

Study Major Dates

• Study Start (Estimated): March 1, 2026
• Primary Completion (Estimated): December 30, 2026
• Study Completion (Estimated): December 30, 2026

Study Registration Dates

• First Submitted: February 25, 2026
• First Submitted That Met QC Criteria: February 25, 2026
• First Posted (Actual): March 3, 2026

Study Record Updates

• Last Update Posted (Actual): March 3, 2026
• Last Update Submitted That Met QC Criteria: February 25, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Postoperative Pain; Regional Anesthesia; Interscalene Block; Suprascapular Nerve Block; Artroscopic Shoulder Surgery
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Musculoskeletal Diseases; Postoperative Complications; Pathologic Processes; Joint Diseases; Arthralgia; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Shoulder Pain
• Other Study ID Numbers: HRÜ/26.01.72

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared.

Drug and device information, study documents

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