This study aims to evaluate the diaphragmatic movement and postoperative analgesia following anterior glenoid, suprascapular, and interscalene nerve blocks in patients undergoing elective arthroscopic shoulder surgery.
Age from 21 to 65 years.
Both sexes.
American Society of Anesthesiologists (ASA) physical status I or II.
Scheduled for arthroscopic shoulder surgery.
Patient's refusal to participate.
Patients with a history of allergy to local anesthetics.
Patients with a history of chronic use of painkillers.
Patients presented with mental dysfunction.
Parallel
Interscalene brachial plexus block
Other interventionPatients will receive general anesthesia, plus an ultrasound-guided interscalene brachial plexus block (ISB) with the injection of 15 mL of 0.25% bupivacaine.
Suprascapular nerve block
Other interventionPatients will receive general anesthesia plus an ultrasound-guided suprascapular nerve block (SSNB) with injection of 15 ml of 0.25% bupivacaine.
Anterior glenoid block
Other interventionPatients will receive general anesthesia plus an ultrasound-guided anterior glenoid block with injection of 15 ml of 0.25% bupivacaine.
Suprascapular nerve block + Anterior glenoid block
Other interventionPatients will receive general anesthesia, along with a total volume of 30 mL of 0.25% bupivacaine, divided into 15 mL for ultrasound-guided SSNB and 15 mL for ultrasound-guided anterior glenoid block.
Incidence of hemi-diaphragmatic paralysis
Incidence of hemi-diaphragmatic paralysis determined by ultrasound-guided assessment of diaphragmatic excursion. Diaphragmatic excursion will be measured before procedure (pre-block), 30 minutes after performing the block and post operative after complete recovery in post-anesthesia care unit (PACU).
Degree of pain
Each patient will be instructed about postoperative pain assessment with the numerical rating scale (NRS) score. NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). NRS will be recorded at T0, 30 min, 2, 4, 6, 12, 18, and 24 hours postoperatively.
Total analgesic consumption
All patients will receive Paracetamol 1 g/6 hours as a regular analgesia and Morphine 3mg if the numerical rating scale (NRS) \> 3 as a rescue analgesia.
Degree of patient satisfaction
The degree of patient satisfaction will be assessed based on a questionnaire and graded on a 4-point scale (excellent/good/fair/poor)
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