This study aims to evaluate whether adding magnesium sulfate to a combined costoclavicular and suprascapular nerve block improves postoperative pain control in patients undergoing shoulder arthroscopy. The study will compare pain management outcomes between patients receiving the nerve block with magnesium sulfate and those receiving the nerve block without magnesium sulfate. The main outcome will be the time to first rescue analgesia after surgery.
Age between 18-50 years
American Society of Anesthesiologists (ASA) physical status I-II.
Scheduled for elective outpatient shoulder arthroscopy.
Ability to understand the study protocol and use the NRS scale.
Refusal to participate.
Known allergy or hypersensitivity to local anesthetics or magnesium sulphate.
Coagulopathy or anticoagulant therapy contraindicating regional anesthesia.
Local infection at the block site.
Parallel
Bupivacaine
Drug"Bupivacaine 0.5% will be used as the local anesthetic for ultrasound-guided costoclavicular and suprascapular nerve blocks. A total of 25 mg (5 mL) will be administered for the costoclavicular nerve block and 50 mg (10 mL) for the suprascapular nerve block, for a total dose of 75 mg per participant."
Magnesium sulfate (MgSO4)
Drug"Magnesium sulfate 150 mg (1.5 mL) will be used as an adjuvant to bupivacaine in each ultrasound-guided nerve block. A total of 300 mg (3 mL) of magnesium sulfate will be administered per participant, with 150 mg added to the costoclavicular nerve block and 150 mg added to the suprascapular nerve block."
Normal Saline (NS)
Drug"Normal saline (0.9% sodium chloride) will be used as the control adjuvant, with 1.5 mL added to the local anesthetic solution for the costoclavicular nerve block and 1.5 mL added to the local anesthetic solution for the suprascapular nerve block, for a total volume of 3 mL per participant."
Costoclavicular Nerve Block
Procedure/Surgery"A single-shot ultrasound-guided costoclavicular nerve block will be performed using 5 mL of 0.5% bupivacaine (25 mg), with either 1.5 mL of magnesium sulfate (150 mg) or 1.5 mL of 0.9% normal saline, according to the assigned study group."
suprascapular nerve block
Procedure/Surgery"A single-shot ultrasound-guided suprascapular nerve block will be performed using 10 mL of 0.5% bupivacaine (50 mg), with either 1.5 mL of magnesium sulfate (150 mg) or 1.5 mL of 0.9% normal saline, according to the assigned study group."
Time to first rescue analgesia after discharge from PACU.
Time to first rescue analgesia will be measured from the time of discharge from the Post-Anesthesia Care Unit (PACU) until the first administration of rescue analgesic medication for 24 hour due to postoperative pain. Numeric Rating Scale (NRS): Pain intensity was assessed using the 11-point Numeric Rating Scale (NRS), in which 0 = no pain and 10 = the worst pain imaginable.
Postoperative Pain Score Using the Numeric Rating Scale
Postoperative pain intensity will be assessed from the end of surgery for 24 hours postoperatively using the Numeric Rating Scale (NRS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst pain imaginable. Higher scores indicate worse pain.
Total Postoperative analgesic Consumption
The total amount of rescue analgesia consumed during the first 24 hours after surgery will be recorded.
Duration of sensory block
Duration of sensory block will be assessed as the time interval from completion of the nerve block to the first administration of rescue analgesia 24 hours postoperatively.
Heart rate
Heart rate will be recorded at predefined perioperative time points to assess hemodynamic stability from baseline before surgery until end of surgery.
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