Combined Suprascapular and Axillary Nerve Blocks for Arthroscopic Shoulder Surgery

Study Overview
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Brief Summary
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Arthroscopic shoulder surgery is associated with severe pain postoperatively. Regional nerve block adding to general anesthesia might improve the quality of postoperative analgesia. The aim of the study is to compare the subacromial local anesthetic infiltration and the suprascapular-axillary nerve blocks combination for intraoperative sevoflurane consumption, postoperative analgesia and analgesic consumption.

Detailed Description
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After informed consent and with ethics approval, 60 ASA 2-3 patients scheduled for elective arthroscopic shoulder surgery will be included in this study. Patient will be divided to two groups by using computer -generated list for randomization. In group A, the surgeon will apply 20 ml of 0.250% bupivacaine to the subacromial region at the end of the procedure. In Group B, suprascapular (10 ml of 0.250% bupivacaine ) and axillary block (10 ml of 0.250% bupivacaine) will be performed with ultrasound and nerve stimulator guidance before induction of anesthesia. In all patients after standard and BIS (Bi spectral index) monitorization general anesthesia will be induced with remifentanil (10mcg iv), propofol (2.5 mg/kg iv) and rocuronium (0.5mg/kg iv). After intubation, anesthesia will be maintained with 50% O2 and N2O mixture. Hemodynamic parameters, BIS values, end-tidal sevoflurane consumption will be recorded by blind investigator. Postoperative visual analog scale (VAS) values, postoperative analgesic consumption (Tramadol, patient controlled analgesia), complications will be recorded.

Official Title
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Combined Suprascapular and Axillary Nerve Blocks for Sevoflurane Consumption and Postoperative Analgesia in Arthroscopic Shoulder Surgery

Conditions
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Arthroscopic Shoulder Surgery, Suprascapular Nerve Block, Axillary Nerve Block

Intervention / Treatment
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* Procedure: Suprascapular nerve- axillary nerve block combination
* Procedure: Subacromial infiltration


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American society of anesthesia physical status (ASA) 1,2 patients Elective arthroscopic shoulder surgery Exclusion Criteria: ASA 3,4 patients Coagulation abnormality Body mass index >30 Preexisting neurological deficit Local anesthetic allergy history Diabetes

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 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 |
| --- | --- |
| Sham Comparator: Group A<br>In group A, the surgeon will apply 20 ml of 0.250% bupivacaine to the subacromial region at the end of the procedure | Procedure: Subacromial infiltration<br>* In group A, the surgeon will apply 20 ml of 0.250% bupivacaine to the subacromial region at the end of the procedure<br>|
| Active Comparator: Group B<br>In Group B, suprascapular (10 ml of 0.250% bupivacaine ) and axillary block (10 ml of 0.250% bupivacaine) will be performed with ultrasound and nerve stimulator guidance before induction of anesthesia | Procedure: Suprascapular nerve- axillary nerve block combination<br>* In Group B, suprascapular (10 ml of 0.250% bupivacaine ) and axillary block (10 ml of 0.250% bupivacaine) will be performed with ultrasound and nerve stimulator guidance before induction of anesthesia<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative VAS scores | Ranging from 0: no pain to 10: worst pain | Through postoperative period, an avarage of 30 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| sevoflurane consumption | End tidal sevoflurane concentration values assesment during the surgery | 5th, 10th,20th,30th,40th,50th minutes after induction of anesthesia |