Upper Trunk Block Versus Costoclavicular Block For Arthroscopic Shoulder Surgery

Study Overview
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Brief Summary
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Interscalene brachial plexus block is known as the gold standard for analgesia after shoulder surgery, but limits the use of ipsilateral phrenic nerve paralysis. Recently, interest in potential diaphragm-sparing alternative blocks has increased for patients undergoing shoulder surgery.Two of these blocks are upper trunk block (UTB) and costoclavicular brachial plexus (CCBPB) block. This randomized controlled trial will compare ultrasound-guided UTB and CCBPB in patients undergoing arthroscopic shoulder surgery. The main outcome is pain intensity score at 30 minutes after arrival in the post anesthesia care unit (PACU) as measured by a numerical rating scale (NRS) from 0 to 10. The investigators research hypothesis is that UTB and CCBPB will result in equivalent postoperative analgesia at 30 minutes in the PACU.

Official Title
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Comparison of Perioperative Analgesic Efficacy of Ultrasonography Guided Upper Trunk Block and Costoclavicular Infraclavicular Brachial Plexus Block in Arthroscopic Shoulder Surgery

Conditions
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Shoulder Pain, Phrenic Nerve Paralysis

Intervention / Treatment
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* Procedure: Upper trunk block
* Procedure: Costoclavicular block
* Procedure: Diaphragmatic function assessment
* Procedure: Cervical plexus blockade


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Association of Anesthesiologists (ASA) physical status I - III BMI 20 to 35 kg / m2 Patients scheduled for elective arthroscopic shoulder surgery Exclusion Criteria: Patients who refuse to participate in the study, Pre-existing (obstructive or restrictive) lung disease, Coagulopathy, Sepsis, Hepatic or renal insufficiency, Pregnancy Allergy to local anesthetic drugs, Chronic pain condition requiring opioid intake at home, Surgery in the neck or infraclavicular region BMI above 40. History of psychiatric diseases needing treatment. Failure of nerve block performed in the preoperative block room Substance abuse history

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Upper trunk block<br>In the supraclavicular region, UTB will be applied with 20 ml % 0.25 bupivacaine with 5 mcg/ml epinephrine. | Procedure: Upper trunk block<br>* Block will be applied to supraclavicular zone by 20 ml % 0.25 bupivacaine with 5 mcg/ml epinephrine .<br>* Other names: Upper trunk brachial plexus block;Procedure: Diaphragmatic function assessment<br>* Diaphragmatic excursion will be assessed under ultrasound immediately before and after regional anesthesia.<br>* Other names: Detection of diaphragmatic paralysis with ultrasound guidance;Procedure: Cervical plexus blockade<br>* Block will be applied at thyroid cartilage level via 10 ml % 0.25 bupivacaine.<br>* Other names: Superficial cervical plexus blockade;|
| Active Comparator: Costoclavicular brachial plexus block<br>In the infraclavicular region, CCBPB will be applied with 20 ml % 0.25 bupivacaine with 5 mcg/ml epinephrine. | Procedure: Costoclavicular block<br>* Block will be applied to infraclavicular zone by 20 ml % 0.25 bupivacaine with 5 mcg/ml epinephrine.<br>* Other names: Costoclavicular brachial plexus block;Procedure: Diaphragmatic function assessment<br>* Diaphragmatic excursion will be assessed under ultrasound immediately before and after regional anesthesia.<br>* Other names: Detection of diaphragmatic paralysis with ultrasound guidance;Procedure: Cervical plexus blockade<br>* Block will be applied at thyroid cartilage level via 10 ml % 0.25 bupivacaine.<br>* Other names: Superficial cervical plexus blockade;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Detection of diaphragmatic paralysis by ultrasonography | Ipsilateral diaphragmatic excursion 30 minutes after block completion | 30 minutes after block application | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative opioid consumption | Total amount of tramadol consumption during the first 24 hours after surgery. Patient controlled analgesia to be inserted. | 24 hour after surgery | 
| Pain intensity score | Postoperative pain assessed with verbal rating scale (VRS 0: no pain 10:pain as bad as can be ) | 30 minutes, 1,3, 6, 12, 24 hour after surgery | 
| Block perform time | Block application time will be recorded | The time from the needle enters the skin until the block is completed | 
| Block onset time | Block onset time will be evaluated and recorded. | Until sensory and motor block occurs | 
| Intraoperative fentanyl requirement | During the operation, 0.5 μg/kg fentanyl was administered to the patient in case of a 20% increase in the mean blood pressure and heart rate compared to the baseline values | From the beginning to the end of the operation | 
| Patient satisfaction: NRS | Patient satisfaction measured using a NRS 0 to 10 (0 = unsatisfied; 10 =very satisfied) | 24 hour after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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bupivacaine, costoclavicular block, upper trunk block