Shoulder surgeries are among the most frequently performed orthopedic interventions and are often associated with moderate to severe postoperative pain. In these procedures, effective pain management is crucial for early rehabilitation and patient comfort.
Peripheral nerve blockade is widely used for postoperative analgesia in shoulder surgery. While the interscalene brachial plexus block is considered the gold standard for pain control, it is frequently associated with unintended phrenic nerve blockade, leading to hemidiaphragmatic paresis. To minimize respiratory complications while maintaining effective analgesia, alternative diaphragm-sparing regional anesthesia techniques, such as the combination of suprascapular and axillary nerve blocks, have been introduced.
The aim of this study is to compare the analgesic efficacy and respiratory functions preservation of the ultrasound-guided anterior approach suprascapular combined with axillary nerve block versus interscalene block in patients undergoing shoulder surgery
Patients aged between 18 and 65 years
American Society of Anesthesiologists (ASA) physical status I, II, or III
Patients scheduled to undergo elective arthroscopic shoulder surgery
BMI between 18 and 30 kg/m2
Known allergy or hypersensitivity to local anesthetics
Presence of localized infection at the planned injection site
Severe coagulopathy or active use of anticoagulant medications
Contralateral phrenic nerve palsy or a diagnosis of severe chronic obstructive pulmonary disease (COPD)
Parallel
Interscalene Block
Procedure/SurgeryInterscalene block will be performed on the patients using 10 mL of 0.5% bupivacaine under ultrasound guidance.
Combination of Axillary and Anterior Suprascapular Blocks
Procedure/SurgeryCombined anterior suprascapular(5 ml) and axillary nerve blocks(5 ml) will be performed on the patients using a total of 10 mL of 0.5% bupivacaine under ultrasound guidance.
Postoperative Pain Intensity at Rest
Pain will be assessed using a visual analog scale from 0 mm (no pain) to 100 mm (worst pain) at rest. Pain assessment at rest will be made at 4 hours after surgery.
Postoperative Pain Intensity at Rest
Pain will be assessed using a visual analog scale from 0 mm (no pain) to 100 mm (worst pain) at rest. Pain assessment at rest will be made at 1, 8, 12, and 24 hours after surgery.
Postoperative Pain Intensity at Movement
Pain will be assessed using a visual analog scale from 0 mm (no pain) to 100 mm (worst pain) at movement. Pain assessment at rest will be made at 1, 4, 8, 12, and 24 hours after surgery.
Total Postoperative Opioid Consumption
The total amount of opioid consumed by the patient will be recorded.
Area Under Curve
Cumulative 24-hour pain burden calculated by the trapezoidal rule
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