Interscalene Block Versus Costoclavicular Block for Shoulder Surgery

A Randomized Comparison Between Interscalene and Costoclavicular Infraclavicular Brachial Plexus Blocks For Arthroscopic Shoulder Surgery

Interscalene brachial plexus block constitutes the analgesic criterion standard for shoulder surgery. However, it is associated with a high incidence of hemidiaphragmatic paralysis (HDP) that may not be tolerated by patients with chronic pulmonary disease. This randomized controlled trial (RCT) will compare ultrasound-guided interscalene block (ISB) and costoclavicular infraclavicular block (CCICB) in patients undergoing arthroscopic shoulder surgery. The main outcome is static pain at 30 minutes after arrival in the post anesthesia care unit (PACU) as measured by a numerical rate scale (NRS) from 0 to 10. Our research hypothesis is that interscalene and costoclavicular infraclavicular blocks will result in equivalent postoperative analgesia at 30 minutes in the PACU. The equivalence margin is set at 2 points.

Injection with ultrasound guidance of 20mL of levobupivacaine 0.5% with 5 micrograms of epinephrine per mL in the interscalene groove of the brachial plexus.

Ultrasound guided brachial plexus block injecting 20mL of 0.5% levobupivacaine with 5 micrograms of epinephrine per mL in between the cords of the brachial plexus at the costoclavicular infraclavicular space.

Percentage of blocks with a minimal sensorimotor composite score of 6 points out of a maximum of 8 points at 30 minutes post injection

Time required to reach a minimal sensorimotor composite score of 6 points out of a maximum of 8 points

Inclusion Criteria: Patients undergoing arthroscopic shoulder surgery American Society of Anesthesiologists classification 1-3 Body mass index between 20 and 35 Exclusion Criteria: Adults who are unable to give their own consent Pre-existing neuropathy Coagulopathy Obstructive or restrictive pulmonary disease Renal failure Hepatic failure Allergy to local anesthetics Pregnancy Prior surgery in the corresponding side of the neck or infraclavicular fossa Chronic pain syndromes requiring opioid intake at home

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