Anterior and Posterior Approaches of Suprascapular Nerve Block

Study Overview
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Brief Summary
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Suprascapular nerve is a mixed motor and sensory peripheral nerve arising from the superior trunk of brachial plexus.The suprascapular nerve runs through the posterior triangle of the neck, anterior of the trapezius muscle and dorsal of the omohyoid muscle, in direction of the scapula. Suprascapular nerve block is performed by anterior and posterior approach. Posterior approach of the suprascapular nerve block has been shown for many years to provide effective analgesia in the shoulder region for the chronic and acute pain. There are studies showing that suprascapular block with anterior approach provides effective analgesia in shoulder arthroscopy. The aim of our study was to compare anterior and posterior approaches of suprascapular nerve block in terms of analgesic efficacy and patient safety.

Detailed Description
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This study is a prospective randomized clinical trial will be conducted between March 2022 and March 2023.Participant will divide into two groups as participant who underwent suprascapular nerve block with the anterior approach and participant who underwent suprascapular nerve block with the posterior approach. Bupivacaine 5 ml %0.5 will be injected both group. Diaphragmatic thickness fraction will be evaluated with ultrasound left and right 7.-8. subcostal anterior axillary border with the participant with the semi-sitting position. Diaphragmatic thickness fraction will measure before the block and after 30 minutes the surgery. Participants will administered intravenous morphine patient controlled analgesia for 24 hours stay. The amount of opioid analgesics given in both groups will be determined (in mg). Postoperative 4th, 6th, 12th, 24th hour Visual Analogue Scale scores of the participants and opioid consumptions until that hours will be evaluated. An addition participant will be determined according to the surgery.

Official Title
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Comparison of Anterior and Posterior Approaches of Suprascapular Nerve Block in Arthroscopic Shoulder Surgery

Conditions
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Shoulder Pain, Postoperative Pain, Diaphragmatic Paralysis, Subomohyoid Suprascapular Nerve Block, Anterior Suprascapular Nerve Block, Suprascapular Nerve Block

Intervention / Treatment
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* Procedure: Posterior suprascapular block
* Procedure: Anterior suprascapular block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient who accepts to study protocol Scheduled for shoulder surgery Between the ages of 18 and 80 Exclusion Criteria: Patients with coagulopathy Patients with a history of local anesthetic drug allergy and toxicity Patients with advanced organ failure Patients with mental retardation Patients with infection present at the injection site Patients with diaphragm paralysis Pregnant patients

Ages Eligible for Study
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Minimum Age: 18 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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: participant with anterior suprascapular block ,group 1 participant with posterior suprascapular block, group 2
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Posterior suprascapular block<br>Suprascapular block performed by posterior approach | Procedure: Posterior suprascapular block<br>* Diaphragmatic thickness fraction will be evaluated in the participant underwent suprascapular block performed by posterior approach<br>|
| Active Comparator: Anterior suprascapular block<br>Suprascapular block performed by anterior approach | Procedure: Anterior suprascapular block<br>* Diaphragmatic thickness fraction will be evaluated in the participant underwent suprascapular block performed by anterior approach<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative pain | Visual analog scale (1-10): 1= no pain, 10= the worst pain ever feel. | The first postoperative 30 minutes | 
| Pain rating | Measured by VAS ( Visual analog scale). | Postoperative 4 hours | 
| Pain Rating | Measured by VAS ( Visual analog scale). | Postoperative 6 hours | 
| Pain Rating | Measured by VAS ( Visual analog scale). | Postoperative 12 hours | 
| Pain Rating | Measured by VAS ( Visual analog scale). | Postoperative 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diaphragmatic movements | Ratio of diaphragm thickness in end-inspiration and end-expiration measured by ultrasonography | Baseline (Before the block performed) and 30 minutes after the end of surgery | 
| Postoperative opioid analgesic consumption (morphine) | milligram | postoperative 4 hours | 
| Postoperative opioid analgesic consumption (morphine) | milligram | postoperative 6 hours | 
| Postoperative opioid analgesic consumption (morphine) | milligram | postoperative 12 hours | 
| Postoperative opioid analgesic consumption (morphine) | milligram | postoperative 24 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Shoulder pain, Nerve Block, Diaphragmatic paralysis, Postoperative pain, Suprascapular block, Subomohyoid suprascapular block, Posterior Suprascapular block, Anterior Suprascapular block