Evaluating the Analgesic Efficacy of Combined Individual Nerve Block in Comparison to Interscalene Nerve Block
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Patients undergoing total shoulder arthroscopic adhesiolysis may experience severe
      postoperative pain. Inadequate pain management can result in unfavourable hospital outcomes
      and the development of persistent neuropathic manifestation the aim of the study is to
      compare both ultrasound techniques (combined individual nerve block to interscalene nerve
      block) as regards the postoperative analgesic effect and shoulder range of movement.
    

Detailed description: 
      60 patients will be attached to standard monitoring, will have a secured intravenous line
      Then the skin overlying the procedure area will be sterilized. all patients will be randomly
      divided into two equal groups; group A will receive ultrasound-guided interscalene block
      (ISNB), and group B will receive ultrasound-guided selective nerve block (SNB) of the
      following nerves; suprascapular nerve block (SSNB), axillary nerve block (ANB), lateral
      pectoral nerve block (LPNB) and musculocutaneous nerve block (MCNB).

      after delivering the nerve block and confirming sensory blockade by loss of cold sensation,
      all the patients will receive general anaesthesia with endotracheal intubation using Propofol
      200mg, Atracurium 0.5 mg/kg, 100 micrograms fentanyl.

      After the procedure ends, the patient will be extubated and transferred to the postoperative
      anaesthesia care unit. All patients will receive patient-controlled analgesia (PCA) in the
      form ketorolac 30 mg and paracetamol one-gram iv infusion.

      The following parameter will be assessed and measured;

        1. Intra-operative inhalation agent consumption

        2. Intraoperative opioid consumption (fentanyl) if required.

        3. Duration of postoperative analgesia and time for first rescue analgesia will be
           recorded. Rescue analgesia in the form of 100mg pethidine IM and 1 gm paracetamol IV
           will be given on the first call for analgesia and then repeated on demand. The total
           dose of pethidine and paracetamol are given throughout the first 24 hours will be
           recorded.

        4. The time for asking for rescue analgesia in the first 24 h and the dose of the analgesic
           used will also be recorded.

        5. The degree of postoperative pain assessed by Visual Analogue Scale (VAS)

        6. Duration of the block: time from completing LA injection till complete recovery of
           sensory function, i.e., the patient feels a cold sensation

        7. Postoperative range of motion of the operated shoulder

        8. Patients" satisfaction (yes or no or somewhat satisfied)

        9. Block-related complications will be also recorded e.g. paraesthesia, and postoperative
           motor weakness 24 hours after the surgery, pneumothorax and vascular puncture.
    

Intervention name(s): interscalene block; selective nerve block; bupivacaine
Intervention type(s): Procedure; Procedure; Drug
Intervention description(s): The patient will be put in the supine position, with the arm adducted a high-frequency linear ultrasound probe is oriented transversely across the lateral neck. When visualizing the ''stoplight sign,''15 to 30 mL of 0.25% bupivacaine will be injected; the patient will be put in the sitting position, linear 38-mm high frequency 10-12 MHz transducer will be placed first on the scapula to view of the suprascapular nerve. 5-8 mL of 0.25% bupivacaine is injected to block the SSN.
The ultrasound probe put on the posterior aspect of the shoulder to view the circumflex artery, 10 mL of 0.25% bupivacaine this will lead to loss of sensation over the deltoid.lateral pectoral nerve block (LPNB) will be done by injecting a volume of 8 ml of a 0.25% bupivacaine The probe will be moved towards the biceps muscle until the musculocutaneous nerve is seen and 8 ml of 0.25% bupivacaine will be injected.; bupivacaine
Intervention MeSH terms: Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention