Interscalene vs Anterior and Posterior Suprascapular Nerve Block for Shoulder Arthroscopic Surgeries

Study Overview
=================
Brief Summary
-----------------
To compare ISB vs anterior and posterior approaches of suprascapular block in terms of lung function and analgesia

Detailed Description
-----------------
Interscalene block (ISB) is commonly used to provide pain control for shoulder surgeries. However, it is associated with several side effects, in particular, a high incidence of phrenic nerve blockade. The suprascapular nerve block (SSB) has been proposed as an alternative to the ISB as it has a lower likelihood of causing phrenic nerve blockade. There are 2 commonly used approaches for the suprascapular nerve block, anterior and posterior. The anterior approach may still result in some degree of impairment of lung function. The primary aim is to assess the pulmonary function after performance of ISB, aSSB and pSSB. Secondary outcomes are analgesic effects and incidence of adverse effects of these blocks.

Official Title
-----------------
Randomised, Controlled Trial Comparing Interscalene Versus Anterior and Posterior Approaches of Suprascapular Nerve Block for Shoulder Arthroscopic Surgeries

Conditions
-----------------
Arthroscopic Shoulder Surgery, Interscalene Block, Suprascapular Nerve Block

Intervention / Treatment
-----------------
* Procedure: ISB
* Procedure: aSSB
* Procedure: pSSB


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients scheduled for elective arthroscopic shoulder surgery under general anaesthesia Patients 21 years old and above American Society of Anesthesiologists (ASA) physical status 1 to 3 BMI 18-35 kg/m2 Exclusion Criteria: Patients unable to give consent or inability to communicate/ cooperate Patients with chronic use of strong opioids (morphine, oxycodone) Patients with allergy to local anaesthetics or any drugs included in the study Patients with contraindications for regional anaesthesia such as coagulopathy Patients with pre-existing neurological deficits in upper limb/ phrenic nerve palsy Patients with pre-existing lung disease (COPD, uncontrolled asthma)

Ages Eligible for Study
-----------------
Minimum Age: 21 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: ISB<br>Interscalene brachial plexus block | Procedure: ISB<br>* ISB block with 0.5% ropivicaine 15mls ( 45mg )<br>|
| Active Comparator: aSSB<br>Anterior Suprascapular Block | Procedure: aSSB<br>* aSSB block with 0.5% ropivicaine 15mls ( 45mg )<br>|
| Active Comparator: pSSB<br>Posterior Suprascapular Block | Procedure: pSSB<br>* pSSB block with 0.5% ropivicaine 15mls ( 45mg )<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pulmonary function | To assess the pulmonary function after performance of interscalene, anterior and posterior approaches to the suprascapular block | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Analgesic effects and complications | Analgesic effect (pain scores, opioid consumption, opioid related side effects), degree of motor blockade and incidence of adverse effects of blocks (Horner's syndrome, hoarseness of voice) | 2 years |