Post Surgical Pain in Arthroscopic Shoulder
Condition: Total Shoulder Arthroplasty
Study type: Interventional

Summary: 
      Postoperative multimodal analgesia methods occupy an essential place in modern anesthesia.
      The postoperative results of opioid analgesia are now at the bottom of the current problems
      due to its side effects. Longer-acting local anesthetics are now effective agents of
      analgesia.

      Investigators aimed to compare the two routine methods. Ultrasonic nerve blocks are the most
      important of multimodal analgesia in modern anesthesia. Suprascapular and axillary nerve
      blocks are routinely used as a safe method. It is a routine method used by periarticular
      local anesthetic surgeons.

      İnvestigators decided to compare which method effectively follows these two methods with the
      postoperative 24 pain scale method.
    

Detailed description: 
      This randomized trial aims to assess if a combined suprascapular-axillary nerve block (CSAB)
      to periarticular injection (PI) treated pain after arthroscopic shoulder surgery. Secondary
      endpoints included opioid consumption, discomfort associated with muscle weakness, and
      patient satisfaction.

      sixty patients undergoing arthroscopic shoulder surgery will be randomized to receive
      ultrasound-guided CSAB (n = 30) or PI (n = 30). Pain intensity at rest and discomfort were
      recorded upon arrival in the recovery room, discharge to the ward, and at 4, 8, and 24 hours
      after surgery. Tramadol consumption was recorded for the first 24 hours. Patient satisfaction
      data will be recorded on the second postoperative day.

      Using a computer-generated random allocation sequence (created by the study statistician),
      patients will randomly be assigned to ultrasound-guided SAB (n = 30) or PI(n = 30).
      Allocation numbers will be sealed in an opaque envelope opening in sequence by an independent
      anesthesiologist who will not assess outcomes. Outcome assessors will be blinded to treatment
      allocation.

      After eligible patients are identified from the registry, patient charts were prospectively a
      blind orthopedist would collect data. Demographic data including sex, age, body mass index,
      surgical procedure, and complications will be recorded. Primary outcome measures were numeric
      rating scale pain scores and 24-hour postoperative opioid consumption. Pain scores will be
      recorded immediately before surgery, immediately following surgery in the postanesthesia
      recovery unit, and 24 hours postoperatively. Total opioid consumption will also be recorded
      for the first 24 hours following surgery. Secondary outcome measures included length of
      surgery, operating room time, perioperative anesthesia time, blood loss, hospital length of
      stay, and intraoperative and 30-day postoperative complication rates. Postoperative
      complications were further categorized as nerve-related, cardiopulmonary, and musculoskeletal
      (fracture or tendon rupture).

      Statisticians will compare statistics between groups using a 2-sample t-test for normally
      distributed variables. The Wilcoxon rank-sum test will be used for non-normally distributed
      variables. A general linear model with correlated errors was used to account for repeated
      pain score assessments over time for each subject. The Fisher exact test will be used for
      categorical variables. Summary statistics will be reported as the mean and standard deviation
      for data analyzed using the 2-sample t-test and general linear models. The median and 25th
      and 75th percentiles will be reported for the Wilcoxon rank-sum test. The frequency (i.e., n)
      and percentage will be reported for data analyzed using the Fisher exact test. A P value of
      .05 will be designated as the threshold for statistical significance.
    

Intervention name(s): shoulder periarticular injection, suprascapular and axillary nerve block
Intervention type(s): Procedure
Intervention description(s): In the PI group, a mixture of 30 ml bupivacaine 0.5% and 30 ml saline solution will be injected by the orthopedist after the wound is closed.
In the CSAB group, a total of 20 ml 0.5% bupivacaine, 10 ml to the suprascapular notch, 10 ml to the axillary nerve, will be administered preoperatively by the anesthesiologist under ultrasound guidance.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: prospective randomized trial, To compare the suprasacuplar-axillary nerve block combined with the periarticular injection method in shoulder arthroscopy cases.
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: shoulder arthroplasty; suprascapular block; axillary nerve block; periarticular injection; ultrasound