Anterior Suprascapular Nerve Block is an Effective and Diaphragm Protective Approach for Arthroscopic Shoulder Surgery
Condition: Diaphragm Paralysis Due to Local Anesthesia; Anterior Suprascapular Nerve Block; Analgesia, Arthroscopic Shoulder Surgery
MeSH terms: Respiratory Paralysis; Paralysis
Study type: Interventional
Phase: Phase 4

Summary: 
      Interscalene block is still the gold standard in shoulder surgery analgesia. The most
      important side effect is diaphragm paralysis due to the phrenic nerve being affected. It may
      cause symptomatic dyspnea, especially in patients with limited respiratory capacity. There
      are studies showing that an effective analgesia, as much as the interscalene block can do,
      can be provided by blocking the suprascapular nerve in the neck region.

      The aim of our study is to show that the anterior suprascapular block applied with ultra-low
      volume (5ml) in shoulder arthroscopy operations is at least as effective as the interscalene
      block and does not cause diaphragm paralysis.
    

Detailed description: 
      Interscalene block is still the gold standard in shoulder surgery analgesia. The most
      important side effect is diaphragm paralysis due to the phrenic nerve being affected. It may
      cause symptomatic dyspnea, especially in patients with limited respiratory capacity. More
      distal brachial plexus blocks have been defined to avoid diaphragmatic paralysis . Thus, it
      is aimed to apply the local anesthetic drug further from the phrenic nerve. With the
      application of ultrasound, the amount of local anesthetic drug was reduced to less than 20
      ml.

      There are studies showing that an effective analgesia, as much as the interscalene block can
      do, can be provided by blocking the suprascapular nerve in the neck region. Although it has
      been shown in a cadaver study that the phrenic nerve can be stained after anterior
      suprascapular nerve block, the clinical effect is not fully known.

      The effect of continuous local anesthetic drug administration on respiratory muscles through
      catheters placed in the peripheral nerve is another matter of concern. The method that will
      not affect the phrenic nerve at all and at the same time provide an effective analgesia is
      still under investigation.

      The aim of our study is to show that the anterior suprascapular block applied with ultra-low
      volume (5ml) in shoulder arthroscopy operations is at least as effective as the interscalene
      block and does not cause diaphragm paralysis. One of the questions that our research aims to
      answer is how the continuous application of local anesthetic drugs affects the diaphragm
      muscle with the insertion of catheters in both regions.
    

Intervention name(s): Evaluation of Diaphragm Movement
Intervention type(s): Other
Intervention description(s): Diaphragmatic movement will be evaluated with ultrasonography and a 5-2 MHz convex transducer will be used. The ultrasound probe is placed between the mid-clavicular line and the anterior axillary line by directing it vertically and slightly cranially. During quiet breathing and deep breathing, diaphragm movement will be measured. The reduction in diaphragm motion will be calculated as the difference (in percent) in diaphragm motion measured before and 30 minutes after the block. Each test will be done 3 times and the values will be averaged. A decrease between 75% and 100% will be defined as complete paresis, a decrease between 25% and 75% as partial paresis, and less than 25% decrease in diaphragmatic movement will be defined as no paresis. In order to investigate the effect of continuous local anesthetic drug administration on diaphragm movement via nerve catheter, the same procedure will be repeated 24 hours after surgery.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The patients will be divided into two groups as patients who underwent suprascapular nerve block with the supraclavicular approach and patients who underwent conventional interscalene nerve block. 5 ml of 0.5% Bupivacaine will be injected into both groups. Diaphragmatic movement will be evaluated with ultrasound at the right and left subcostal border with the patients in a semi-sitting position. The reduction in diaphragm motion will be calculated as the difference (in percent) in diaphragm motion measured before and 30 minutes after the block.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: arthroscopic shoulder surgery; Interscalene nerve block; Anterior suprascapular nerve block; Analgesia, postoperative; Diaphragm paralysis