Diaphragmatic Paralysis After Ultrasound Block of the Suprascapular Nerve for Shoulder Surgery

Study Overview
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Brief Summary
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Shoulder surgery is a source of intense postoperative pain that justifies the use of opioids. In this context, analgesia provided by locoregional anesthesia (ALR) improves the rehabilitation of patients by reducing the length of hospital stay and morphine consumption. Thus anesthesia of the brachial plexus interscalene (interscalene block or BIS) is considered as the reference technique for the management of post-operative pain after shoulder surgery. It is however provider of hemi-diaphragmatic paralysis (PhD) in nearly 100% of cases. Thus, this technique is usually avoided in patients with respiratory insufficiency. In arthroscopic shoulder surgery, the development of a suprascapular and axillary nerve (SSAX) conjugate block appears to be an effective analgesic alternative in this context.

Detailed Description
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Two ultrasound-guided approaches of the suprascapular nerve (anterior and posterior approaches) have been described in the literature. From an anatomical point of view, the anterior approach could expose patients to the risk of ipsilateral PhD by phrenic nerve block secondary to diffusion of the local anesthetic into the supraclavicular region. By measuring the diaphragm excursion during a sniff test, ultrasound allows reliable and reproducible analysis of the diaphragm function. No study has evaluated the incidence of PhD after ultrasound block of the suprascapular nerve. Knowing the influence of the approach on this complication could be of major interest in this context.

Official Title
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Diaphragmatic Paralysis After Ultrasound Block of the Suprascapular Nerve for Shoulder Surgery : Incidence and Influence of the Approach

Conditions
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Surgery

Intervention / Treatment
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* Procedure: anterior SSAX
* Procedure: posterior SSAX


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: to benefit from scheduled arthroscopic surgery of the shoulder under general anesthesia Affiliate or beneficiary of a social security scheme Having signed the informed consent Exclusion Criteria: the existence of contralateral diaphragmatic paralysis pre-existing respiratory insufficiency impossibility of performing diaphragmatic ultrasound the patient's refusal the existence of major spontaneous or acquired haemostatic disorders an infection at the point of puncture allergy to local anesthetics Pregnant or likely to be pregnant Patients under protection of the adults (guardianship, curators or safeguard of justice) Patients whose cognitive state does not allow assessment by the scales used

Ages Eligible for Study
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Minimum Age: 18 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: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Anterior SSAX<br>patients receiving suprascapular and axillary nerve block (SSAX) whose approach to the SS nerve is performed by anterior route | Procedure: anterior SSAX<br>* block of the suprascapular nerve block for shoulder surgery by anterior way<br>|
| Experimental: Posterior SSAX<br>patients receiving suprascapular and axillary nerve block (SSAX) whose approach to the SS nerve is performed by posterior route | Procedure: posterior SSAX<br>* block of the suprascapular nerve block for shoulder surgery by posterior way<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in diaphragmatic excursion | measured on ultrasound between the 30th minute after SSAX and the basal state (i.e. prior to regional anesthesia). The diaphragmatic excursion is the distance traveled by the diaphragm between the functional residual capacity (CRF) and the forced inspiration during a rapid voluntary sniffing (or sniff test). | 30 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PhD over time | diaphragmatic excursion by a repeated ultrasound during a sniff test in the basal state (ie before regional anesthesia), then 30 minutes, 4 hours and finally 8 hours after realization of the ALR | Baseline, 30 minutes, 4 hours and 8 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Shoulder surgery, Local regional anesthesia