Interscalene Brachial Plexus Block Combined With Suprascapular Nerve Block

Study Overview
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Brief Summary
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The investigators compared the results of sono-guided interscalene brachial plexus block (ISB) combined with arthroscopy-guided suprascapular nerve block (SSNB) with those of ISB alone within the first 48 h after arthroscopic rotator cuff repair.

Detailed Description
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Forty-eight patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled. The 24 patients randomly allocated to group 1 received ISB and SSNB; the remaining 24 patients in group 2 underwent ISB alone. VAS pain score, patient's satisfaction (SAT) were checked postoperative 1, 3, 6, 12, 18, 24, 36, and 48 hours. VAS pain score was selected from 0 to 10 was no pain and 10 was severe pain that the patient had ever experienced. SAT was also selected from 0 to 10 was unsatisfactory and 10 was very satisfactory. Rebound of postoperative pain was confirmed if there had been an increase of VAS pain score after postoperative 1 hour.

Official Title
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The Effect of Sono-Guided Interscalene Brachial Plexus Block Combined With Arthroscopy-Guided Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

Conditions
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Rotator Cuff Injury

Intervention / Treatment
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* Device: Ultrasound-guided ISB
* Device: Arthroscopy-guided SSNB
* Drug: Placebo
* Drug: Ropivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: definite rotator cuff tear on preoperative MRI, which needed repair; acceptance of arthroscopic surgery including rotator cuff repair; > 20 years old; and acceptance of routine regional blocks and patient-controlled analgesia. Exclusion Criteria: did not want arthroscopic rotator cuff repair; stopped PCA before 48 h postoperatively due to side effects; history of shoulder operation or fracture; concomitant neurological disorder around the shoulder; conversion to open surgery from the arthroscopy; and contraindication to the routine regional blocks in this study

Ages Eligible for Study
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Minimum Age: 20 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: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: ISB with SSNB<br>During arthroscopic rotator cuff repair, ultrasound-guided ISB was performed preemptively with 7.5 mL ropivacaine immediately after general anesthesia was induced. And at the end of surgery, arthroscopy-guided SSNB was performed with 10 mL ropivacaine. | Device: Ultrasound-guided ISB<br>* ISB was performed by one anesthesiologist under ultrasound-guidance. The superior, middle, and inferior trunks of the brachial plexus were identified approximately 2 cm above the clavicle. A 50 mm 22-gauge needle was introduced percutaneously using an out-of-plane technique. The needle was placed beside each trunk in succession, and 2.5 mL ropivacaine was injected into each site. The total volume of ropivacaine used for ISB was 7.5 mL.<br>Device: Arthroscopy-guided SSNB<br>* At the end of the surgery, SSNB was performed under arthroscopic guidance by one shoulder arthroscopist. The suprascapular ligament was found using the lateral portal for visualization. The supraclavicular ligament was visualized at the end of the conoid ligament when the arthroscope was advanced following the coracoclavicular ligament. A 23-gauge spinal needle was introduced in a posteroanterior direction at a 20° angle percutaneously and 7 cm medial to the lateral margin of the acromion. Then, the needle was placed at the upper margin of the suprascapular ligament and advanced slightly under arthroscopy-guidance. After suctioning the saline from the portal, the injection material was administered according to the random assignment.<br>Drug: Placebo<br>* All the regional blocks in this study were performed using ropivacaine, except for arthroscopy-guided SSNB using placebo (10 mL normal saline)<br>Drug: Ropivacaine<br>* All the regional blocks in this study were performed using 10mL ropivacaine.<br>|
| Placebo Comparator: ISB alone<br>During arthroscopic rotator cuff repair, ultrasound-guided ISB was performed preemptively with 7.5 mL ropivacaine immediately after general anesthesia was induced. And at the end of surgery, arthroscopy-guided SSNB was performed with 10 mL normal saline. | Device: Ultrasound-guided ISB<br>* ISB was performed by one anesthesiologist under ultrasound-guidance. The superior, middle, and inferior trunks of the brachial plexus were identified approximately 2 cm above the clavicle. A 50 mm 22-gauge needle was introduced percutaneously using an out-of-plane technique. The needle was placed beside each trunk in succession, and 2.5 mL ropivacaine was injected into each site. The total volume of ropivacaine used for ISB was 7.5 mL.<br>Drug: Placebo<br>* All the regional blocks in this study were performed using ropivacaine, except for arthroscopy-guided SSNB using placebo (10 mL normal saline)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analog Scale (VAS) Pain Score | The VAS pain score was based on a scale from 0 to 10, where 0 indicated no pain and 10 indicated severe pain | 1, 3, 6, 12, 18, 24, 36, 48h | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Satisfaction (SAT) Score | The SAT score was also from 0 to 10, where 0 indicated unsatisfactory and 10 indicated very satisfactory. | 1, 3, 6, 12, 18, 24, 36, 48h | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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sono-guided interscalene brachial plexus block, arthroscopy-guided suprascapular nerve block, arthroscopic rotator cuff repair, postoperative pain