Modified PENG Plus Suprascapular Nerve Block Versus Interscalene Block for Bankart and Latarjet Surgery

Comparative Efficacy of Modified PENG Block Combined With Suprascapular Nerve Block Versus Interscalene Block for Bankart Repair and the Latarjet Surgery : A Randomized Controlled Trial

This randomized controlled trial aims to compare the analgesic efficacy and safety of a Modified Pericapsular Nerve Group (PENG) Block combined with Suprascapular Nerve Block (SSNB) versus Interscalene Brachial Plexus Block (ISB) in adult patients undergoing elective Bankart repair or Latarjet surgery under general anesthesia. Seventy patients will be randomized to receive either Modified PENG plus SSNB or ISB. The primary outcome is postoperative pain intensity measured by the Visual Analog Scale (VAS) at 24 hours. Secondary outcomes include opioid consumption, time to first rescue analgesia, functional recovery, range of motion, and block-related complications including respiratory compromise, motor weakness, Horner syndrome, hoarseness, and local anesthetic systemic toxicity. This randomized controlled trial aims to compare the analgesic efficacy and safety of a Modified Pericapsular Nerve Group (PENG) Block combined with Suprascapular Nerve Block (SSNB) versus Interscalene Brachial Plexus Block (ISB) in adult patients undergoing elective Bankart repair or Latarjet surgery under general anesthesia. Seventy patients will be randomized to receive either Modified PENG plus SSNB or ISB. The primary outcome is postoperative pain intensity measured by the Visual Analog Scale (VAS) at 24 hours. Secondary outcomes include opioid consumption, time to first rescue analgesia, functional recovery, range of motion, and block-related complications including respiratory compromise, motor weakness, Horner syndrome, hoarseness, and local anesthetic systemic toxicity.

Study Overview

• Status: Recruiting
• Conditions: Shoulder Instability
• Intervention / Treatment: Procedure: • Modified PENG Block combined with Suprascapular Nerve Block; Procedure: • Interscalene Brachial Plexus Block

Detailed Description

Shoulder stabilization procedures such as Bankart repair and the Latarjet procedure are associated with significant postoperative pain. The interscalene brachial plexus block is considered the standard regional anesthetic technique but is associated with complications including phrenic nerve paralysis and motor weakness. This study evaluates whether a Modified PENG Block combined with Suprascapular Nerve Block can provide comparable postoperative analgesia while reducing block-related complications. This is a prospective, single-center, randomized controlled trial involving 70 ASA I-II adult patients undergoing elective shoulder stabilization surgery at Kasr Al-Ainy Hospital, Cairo University. Participants will be randomly allocated to receive either Modified PENG plus SSNB or ISB before general anesthesia. Pain scores, opioid consumption, time to first rescue analgesia, functional recovery, hemodynamic parameters, and adverse events will be assessed during the first 24 postoperative hours and during follow-up according to the study protocol

• Study Type: Interventional
• Enrollment (Estimated): 70
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ahmed Hamza Ibrahem Mohamed, MD; Phone Number: +20 1159518716 +201159518716; Email: ahmedmedohamza@gmail.com

Study Locations

• Egypt
  • Cairo Governorate
    • Cairo, Cairo Governorate, Egypt
      • Recruiting
      • Faculty of Medicine , Cairo University Hospitals
      • Contact: ahmed hamza ibrahem mohamed, md; Phone Number: +201159518716; Email: ahmedmedohamza@gmail.com
      • Principal Investigator: Ahmed Zaghloul Foaad, Professor of Anaesthesia

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• • Male or female patients aged 18 to 65 years.

  • Patients undergoing elective Bankart repair or Latarjet surgery.
  • American Society of Anesthesiologists (ASA) physical status I or II.

Exclusion • Patient refusal.

• History of allergy to local anesthetics.
• Chronic opioid use (>3 months).
• Coagulation disorders.
• Pre-existing neurological or musculoskeletal disorders.
• Respiratory compromise (e.g., COPD)

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Modified PENG + Suprascapular Nerve Block (SSNB); Participants receive an ultrasound-guided Modified Pericapsular Nerve Group (PENG) Block combined with Suprascapular Nerve Block (SSNB) before induction of general anesthesia for elective Bankart repair or Latarjet surgery. The Modified PENG Block is performed with 20 mL of 0.25% bupivacaine and the SSNB with 10 mL of 0.25% bupivacaine.	Procedure: • Modified PENG Block combined with Suprascapular Nerve Block; Ultrasound-guided Modified Pericapsular Nerve Group (PENG) Block combined with Suprascapular Nerve Block (SSNB) performed before induction of general anesthesia. The Modified PENG Block is performed with 20 mL of 0.25% bupivacaine and the SSNB with 10 mL of 0.25% bupivacaine for postoperative analgesia in patients undergoing elective Bankart repair or Latarjet surgery
Active Comparator: Interscalene Brachial Plexus Block (ISB); Participants receive an ultrasound-guided Interscalene Brachial Plexus Block (ISB) using 20 mL of 0.25% bupivacaine before induction of general anesthesia for elective Bankart repair or Latarjet surgery	Procedure: • Interscalene Brachial Plexus Block; Ultrasound-guided Interscalene Brachial Plexus Block performed before induction of general anesthesia using 20 mL of 0.25% bupivacaine for postoperative analgesia in patients undergoing elective Bankart repair or Latarjet surgery

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Analog Scale (VAS) Pain Score at Rest at 24 Hours Postoperatively	Pain intensity at rest will be assessed using the Visual Analog Scale (VAS) for pain, ranging from 0 (no pain) to 10 (worst imaginable pain), 24 hours after surgery. Higher scores indicate worse pain. The primary comparison is between the Modified PENG Block combined with Suprascapular Nerve Block and the Interscalene Brachial Plexus Block.	24 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total opioid consumption		during the first 24 hours.
Visual Analog Scale (VAS) Pain Scores at Postoperative Time Points	Pain intensity will be assessed using the Visual Analog Scale (VAS) for pain, ranging from 0 (no pain) to 10 (worst imaginable pain). Higher scores indicate worse pain. Scores will be recorded at multiple postoperative time points.	multiple postoperative time points.

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Principal Investigator: Ahmed Zaghloul Foaad, Professor of Anaesthesia, Cairo University

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2026
• Primary Completion (Estimated): November 1, 2026
• Study Completion (Estimated): November 29, 2026

Study Registration Dates

• First Submitted: June 30, 2026
• First Submitted That Met QC Criteria: June 30, 2026
• First Posted (Actual): July 7, 2026

Study Record Updates

• Last Update Posted (Actual): July 8, 2026
• Last Update Submitted That Met QC Criteria: July 6, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: MD-248-2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared because there is no plan for public data sharing. Only aggregated study results will be reported in scientific publications while maintaining participant confidentiality.Individual participant data will not be shared because there is no plan for public data sharing. Only aggregated study results will be reported in scientific publications while maintaining participant confidentiality.

Drug and device information, study documents

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