Nerve Stimulator Versus Ultrasound-guided Interscalene Block for Shoulder Surgery

Study Overview
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Brief Summary
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The investigators compared the postoperative analgesia of nerve stimulator-guided and ultrasound-guided interscalene block after shoulder surgery.

Detailed Description
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Ultrasound (US)-guided peripheral nerve block has increased in popularity. It has many advantages such as improved success rate, faster onset time, fewer needle passes, shorter performance time, and reduced procedural pain and vascular puncture. However, there is no information about postoperative analgesia. Therefore, the investigators tested whether nerve stimulator (NS) - guided interscalene block was inferior to ultrasound-guided block in terms of duration of postoperative analgesia for shoulder surgery.

Official Title
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A Randomized Comparison of Nerve Stimulator-guided and Ultrasound-guided Interscalene Block for Shoulder Surgery

Conditions
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Pain

Intervention / Treatment
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* Procedure: NS-guided interscalene block
* Procedure: US-guided interscalene block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiologists physical class I - III patients scheduled to undergo shoulder surgery Exclusion Criteria: coagulopathy, severe pulmonary disease, neuropathy, contralateral diaphragmatic paresis, allergy to study medications

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: NS-guided interscalene block<br>NS-guided interscalene block is performed using 20 ml of 0.75% ropivacaine. | Procedure: NS-guided interscalene block<br>* Patients received a standard single injection interscalene block using the modified lateral approach of Borgeat. The interscalene brachial plexus was identified using an insulated needle connected to a nerve stimulator. An insulated needle attached to a nerve stimulator was used to identify the brachial plexus. Placement of the needle was considered adequate if the deltoid, triceps, pectoralis, or biceps muscle motor response was still present at 0.2 - 0.5mA. Ropivacine 0.75% 20ml was used.<br>|
| Experimental: US-guided interscalene block<br>US-guided interscalene block is performed using 20 ml of 0.75% ropivacaine. | Procedure: US-guided interscalene block<br>* Interscalene block is performed under ultrasound guidance. Linear probe is placed on the ipsilateral interscalene groove visualizing the brachial plexus located between anterior and middle scalene muscles. Using in-plane technique, an insulated needle is advanced into the brachial plexus sheath, into which 20 ml of 0.75% ropivacaine is injected<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| duration of postoperative analgesia | time from completion of local anesthetic injection until the first request for an analgesic | at 24h after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| onset time (complete block of sensory and motor nerve) | complete block of sensory and motor nerve | until 30min after completion of local anesthetic | 
| patient discomfort (pain score (0 -10) during the procedure) | pain score (0 -10) during the procedure | at 30 min after block placement | 
| block performance time (the time between the block needle insertion and needle withdrawal) | the time between the block needle insertion and needle withdrawal. | at 30 min after block placement | 
| The number of needle redirections | either forward or backward movement of needle at least 1 cm or more | at 30 min after block placement | 
| paresthesia (presence of paresthesia during the procedure) | presence of paresthesia during the procedure | at 30 min after block placement | 
| motor block of hand | degree of motor block in the operated hand | at 30 min after block placement | 
| paresthesia of hand | presence of paresthesia in the operated hand | at 30 min after block placement | 
| Supplemental analgesia |  | at 24h after surgery | 
| Pain score | numerical rating scale (0 - 10) | at 24h after surgery | 
| Patient satisfaction | Patient satisfaction was evaluated using a two-point score: 1, satisfactory (if necessary, I would have the same anesthetic technique); and 2, unsatisfactory (different anesthetic technique). | at 24h after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ultrasound, nerve stimulator