SPENG Block Versus Suprascapular and Axillary Nerve Blocks for Pain After Shoulder Arthroscopy
Trial statusNot yet recruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18-70
SponsorIzmir City Hospital
About this trial
This prospective, randomized, patient- and assessor-blinded, single-center non-inferiority trial will compare the analgesic efficacy of the Shoulder Posterior Pericapsular Nerve Group (SPENG) block with combined posterior suprascapular and axillary nerve blocks in adults undergoing elective shoulder arthroscopy under general anesthesia. Both groups will receive the same total volume and concentration of local anesthetic. The primary outcome will be the highest resting Numeric Rating Scale pain score recorded during the first 24 postoperative hours. Secondary outcomes will include block performance time, sensory block success in suprascapular and axillary nerve territories, opioid consumption, time to rescue analgesia, motor function, diaphragmatic function, postoperative recovery quality, patient satisfaction, and block-related complications.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Age 18 to 70 years
American Society of Anesthesiologists (ASA) physical status I-III
Scheduled to undergo elective shoulder arthroscopy under general anesthesia
Able to understand the Numeric Rating Scale for pain assessment
Disqualifiers
Known allergy or hypersensitivity to local anesthetics used in the study
Infection at the planned block injection site
Coagulopathy or ongoing anticoagulant therapy that cannot be appropriately interrupted for peripheral nerve block
Pre-existing neurological deficit affecting the operative upper extremity
Trial design
Design model
Parallel
Treatments tested in this trial
Shoulder Posterior Pericapsular Nerve Group (SPENG) Block
Procedure/SurgeryAn ultrasound-guided single-injection posterior pericapsular block. With the participant in the lateral decubitus position and the operative shoulder uppermost, a high-frequency linear ultrasound transducer will be placed transversely immediately inferior to the posterior acromion. After identification of the humeral head, articular cartilage, infraspinatus muscle, and posterior glenoid rim, a block needle will be advanced in-plane in a medial-to-lateral direction. The needle tip will be positioned between the posterior glenoid rim and the deep surface of the infraspinatus muscle, and 20 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be injected.
Combined Posterior Suprascapular and Axillary Nerve Blocks
Procedure/Surgerywo ultrasound-guided nerve blocks will be performed. For the posterior suprascapular nerve block, the suprascapular nerve will be identified in the suprascapular notch region beneath the supraspinatus muscle, and 10 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be administered. For the axillary nerve block, the posterior humeral circumflex artery will be identified using color Doppler in the quadrilateral space, and 10 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be administered adjacent to the axillary nerve.
Treatment groups
60 Participants
are divided into 2 treatment groupsGroup A: SPENG BlockExperimental treatment 1 intervention
Group B: Posterior Suprascapular and Axillary Nerve BlocksActive comparator 1 intervention
Trial outcomes
Primary outcomes
1
Highest Resting Numeric Rating Scale Pain Score During the First 24 Postoperative Hours
Resting postoperative pain intensity will be assessed using an 11-point Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). For each participant, the highest resting NRS score recorded during the first 24 postoperative hours will be used as the primary outcome. Scheduled assessments will be performed on arrival in the post-anesthesia care unit and at 4, 8, 12, and 24 hours after surgery. Resting NRS scores obtained immediately before rescue analgesic administration outside these scheduled assessments will also be included when determining the highest value.
Time frame
From arrival in the post-anesthesia care unit through 24 hours after surgerySecondary outcomes
1
Block Performance Time
Time required to perform the allocated regional anesthesia technique, measured in seconds from the first contact of the ultrasound transducer with the skin until removal of the block needle after completion of local anesthetic injection.
Time frame
Periprocedural2
Proportion of Participants With Complete Dual-Target Sensory Block Success
Cold sensation will be assessed over the posterior shoulder (suprascapular nerve territory) and lateral deltoid region (axillary nerve territory) using a 3-point scale: 0 = absent sensation, 1 = reduced sensation, and 2 = normal sensation. Suprascapular sensory component success will be defined as a reduction of at least one grade from baseline in the posterior shoulder region. Axillary sensory component success will be defined as a reduction of at least one grade from baseline in the lateral deltoid region. Complete dual-target sensory block success will require successful sensory blockade in both territories in the same participant.
Time frame
30 minutes after block completion3
Cumulative Opioid Consumption During the First 24 Postoperative Hours
All rescue opioid analgesics administered during the first 24 postoperative hours will be recorded and converted to intravenous morphine-equivalent dose for comparison between groups.
Time frame
From arrival in the post-anesthesia care unit through 24 hours after surgery4
Time to First Rescue Analgesic
Time from completion of the study block to the first administration of rescue analgesic medication for postoperative pain.
Time frame
From block completion through 24 hours after surgeryLocations
Sponsors and contacts
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Source ClinicalTrials.gov
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