Nerve Block for Postoperative Shoulder Pain

Overseen By Farzin Ahmed

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Texas Southwestern Medical Center

Must not be taking: Opioids, Liposomal anesthetics

Disqualifiers: Chronic pain, Pulmonary disease, others

Compensation: Varies

Number of Visits: 1

Duration: 1 day

74 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, if you are using opioids or have allergies to certain medications, you may not be eligible to participate.

What data supports the effectiveness of the treatment Intercostobrachial Nerve Block for postoperative shoulder pain?

The intercostal nerve block, which is similar to the intercostobrachial nerve block, has been shown to be effective for controlling pain after upper abdominal and thoracic surgery, suggesting it may also help with shoulder pain after surgery. ^{1 2 3 4 5}

Is the nerve block for postoperative shoulder pain generally safe?

Nerve blocks for shoulder pain, like the interscalene brachial plexus block, are generally safe but can have rare serious complications, such as total spinal anesthesia or spinal cord damage, if not performed correctly. ^{1 6 7 8 9}

How does the nerve block treatment for postoperative shoulder pain differ from other treatments?

The nerve block treatment for postoperative shoulder pain, specifically the interscalene brachial plexus nerve block, is unique because it uses ultrasound guidance to precisely target nerves, providing effective and long-lasting pain relief with high patient satisfaction and minimal complications. This method is different from standard intravenous pain medications, as it directly blocks nerve signals in the shoulder area, reducing the need for opioids and enhancing recovery. ^{1 2 10 11 12}

What is the purpose of this trial?

Interscalene blocks are frequently performed to decrease postoperative pain after shoulder surgeries and are considered the gold standard for pain control after this type of surgery. Some patients report pain in the axilla (armpit) following shoulder replacement surgeries. Sensation in the axilla is supplied by nerves not covered by the interscalene block. Sensation in the axilla can be decreased by performing an intercostobrachial nerve block. This study aims to study whether adding an intercostobrachial nerve block to the interscalene block decreases recovery room stay time, opioid pain medication requirement, and postoperative pain scores.

Research Team

Farzin Ahmed

Principal Investigator

[e-mail]

Eligibility Criteria

This trial is for adults aged 18-70 with a BMI under 35 who are scheduled for primary total shoulder arthroplasty or reverse total shoulder arthroplasty and expect to go home the same day. They must be able to understand and agree to participate in the study.

Inclusion Criteria

You are capable of providing consent to participate in the study.

I am scheduled for a primary or reverse total shoulder replacement.

I expect to go home the same day as my surgery.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either an active or sham intercostobrachial nerve block in addition to the standard interscalene block for shoulder pain management

1 day

1 visit (in-person)

Follow-up

Participants are monitored for postoperative pain, recovery room stay time, and opioid pain medication requirement

4 weeks

Treatment Details

Interventions

• Intercostobrachial Nerve Block

Trial Overview The study is testing if adding an intercostobrachial nerve block to the standard interscalene block can reduce pain, decrease recovery room time, and lower the need for opioid painkillers after shoulder replacement surgery.

Participant Groups

Group I: Active intercostobrachial nerve block Active Control 1 Intervention

Patient will receive local anesthetic injected around their intercostobrachial nerve in the axilla (armpit). They will still receive an active interscalene nerve block (gold standard) that helps with the rest of the shoulder pain.

Group II: Sham intercostobrachial nerve block Placebo Group 1 Intervention

Patient will receive saline injected around their intercostobrachial nerve in the axilla (armpit). This is a sham intercostobrachial nerve block because saline is not an active medication. They will still receive an active interscalene nerve block (gold standard) that helps with the rest of the shoulder pain.

Who Is Running the Clinical Trial?

University of Texas Southwestern Medical Center

Lead Sponsor

Trials

1,102

Recruited

1,077,000+

Findings from Research

The modified lateral approach for interscalene catheter placement in 700 patients resulted in a high success rate for anesthesia (97%) and effective postoperative pain relief (99%), indicating its efficacy for shoulder surgery.

The study reported low rates of complications, with only 0.7% experiencing local infections and minor neurologic issues observed in 2.4% of patients, while patient satisfaction averaged 9.6 out of 10, highlighting the safety and acceptability of the procedure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of the lateral modified approach for continuous interscalene block after shoulder surgery. Borgeat, A., Dullenkopf, A., Ekatodramis, G., et al.[2019]

The anterior suprascapular nerve block (SSNB) provided slightly better pain control than the interscalene brachial plexus block (ISB) after shoulder surgery, with a mean pain level 0.32 units lower, while still being noninferior in effectiveness.

SSNB resulted in significantly less grip strength impairment, with 99% of patients maintaining unimpaired grip strength compared to only 49% in the ISB group, making SSNB a safer and more effective option for postoperative pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Anterior Suprascapular Nerve Block Versus Interscalene Brachial Plexus Block for Shoulder Surgery in the Outpatient Setting: A Randomized Controlled Patient- and Assessor-Blinded Trial. Wiegel, M., Moriggl, B., Schwarzkopf, P., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Patient-Reported Outcomes After Arthroscopic Shoulder Surgery With Interscalene Brachial Plexus Nerve Block Using Liposomal Bupivacaine: A Prospective Observational Study. [2020]

2. United States pubmed.ncbi.nlm.nih.gov

Evaluation of the lateral modified approach for continuous interscalene block after shoulder surgery. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

Intercostal nerve block. [2004]

4. United States pubmed.ncbi.nlm.nih.gov

Low-volume interscalene brachial plexus block for post-thoracotomy shoulder pain. [2013]

5. United States pubmed.ncbi.nlm.nih.gov

The effect of interscalene block on ipsilateral shoulder pain and pulmonary function in patients undergoing lung lobectomy: A randomized controlled trial. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Anterior Suprascapular Nerve Block Versus Interscalene Brachial Plexus Block for Shoulder Surgery in the Outpatient Setting: A Randomized Controlled Patient- and Assessor-Blinded Trial. [2022]

7. Netherlands pubmed.ncbi.nlm.nih.gov

Inadvertent total spinal anesthesia after intercostal nerve block placement during lung resection. [2013]

8. United States pubmed.ncbi.nlm.nih.gov

Cervical myelopathy caused by retrograde intraneural dissection of anesthetic solution. [2014]

9. China (Republic : 1949- ) pubmed.ncbi.nlm.nih.gov

Dexamethasone Versus Ketamine in the Interscalene Block in Patients Undergoing Arthroscopic Shoulder Surgery: A Randomized Double-Blinded Study. [2019]

10. United States pubmed.ncbi.nlm.nih.gov

Complications of intercostal nerve blocks performed under direct vision during thoracotomy: a report of two cases. [2004]

11. United States pubmed.ncbi.nlm.nih.gov

Ultrasound-guided interscalene block for postthoracotomy ipsilateral shoulder pain. [2008]

12. Germany pubmed.ncbi.nlm.nih.gov

[Pain management in shoulder surgery]. [2018]