xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT05982951</url>
    </required_header>
    <id_info>
      <org_study_id>GeneralCTHI</org_study_id>
      <nct_id>NCT05982951</nct_id>
    </id_info>
    <brief_title>A Comparative Study Between Ultrasound Guided Shoulder Block and Pericapsular Nerve Group Bock for Shoulder Arthroscopic Surgeries: Double Blinded Randomized Clinical Trial</brief_title>
    <official_title>A Comparative Study Between Ultrasound-guided Shoulder Block and Pericapsular Nerve Group Bock for Shoulder Arthroscopic Surgeries.</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>General Committee of Teaching Hospitals and Institutes, Egypt</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>General Committee of Teaching Hospitals and Institutes, Egypt</source>
    <oversight_info>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        Shoulder arthroscopic surgeries are one of the most common procedures performed on a daily&#xD;
        basis in our practice. The arthroscopic techniques offer a lesser invasive option as Open&#xD;
        repair does not offer a significantly better 2-year result in terms of stability, and&#xD;
        furthermore, can negatively affect the recovery of the full range of motion of the shoulder.&#xD;
        Open techniques Shoulder procedures are performed arthroscopically nowadays with fewer&#xD;
        complications compared with open surgery.&#xD;
  &#xD;
        Indications of shoulder arthroscopy are expanding and include biceps tears, labral tears,&#xD;
        rotator muscles tears, subacromial impingements chondral injuries, loose bodies, early&#xD;
        degenerative changes, adhesive capsulitis, shoulder instability and acromioclavicular&#xD;
        osteoarthritis.&#xD;
  &#xD;
        There are many regional anesthetic techniques used to control perioperative pain during&#xD;
        arthroscopic procedures. Interscalene block results in effective shoulder surgery analgesia,&#xD;
        but it is associated with various complications such as diaphragmatic paralysis due to the&#xD;
        high incidence of phrenic nerve block.&#xD;
  &#xD;
        The suprascapular nerve block combined with the axillary nerve block is non-inferior to&#xD;
        conventional inter-scalene block except for the early recovery period with the advantage of&#xD;
        lower incidence of dyspnea and discomfort.&#xD;
  &#xD;
        . In a cadaveric anatomical study that the posterosuperior quadrant and the posteroinferior&#xD;
        quadrant of the GHJ were innervated by the suprascapular nerve and the axillary nerve&#xD;
        respectively. While the anterosuperior quadrant portion of the joint is sensory supplied by&#xD;
        the subscapularis superior branch and the anteroinferior by the main branch of the axillary&#xD;
        nerve. These anatomical data the possibility of a new block targeting the GHJ sensory&#xD;
        branches. It was suggested that deep pericapsular infiltration of local anesthetic towards&#xD;
        the subscapularis may cover the axillary and subscapularis branches that feed the&#xD;
        anteroinferior and superior quadrants of the GHJ.&#xD;
  &#xD;
        Recently, the pericapsular nerve group block of the shoulder joint as described in a case&#xD;
        series including two cases underwent a humeral neck fracture fixation and Bankart&#xD;
        arthroscopic repair with promising anesthesia and analgesia in selected shoulder surgeries.&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        anesthetics Bleeding disorders receiving antiplatelet or anticoagulant drugs local infection&#xD;
        at site of local injection Intra articular infections&#xD;
  &#xD;
        Sample size and methodology:&#xD;
  &#xD;
        WE will enroll 42 patient undergoing elective shoulder arthroscopy. They will be randomized&#xD;
        and allocated into two groups; Group A and group B. Group A will receive ultrasound guided&#xD;
        PENG block and group B will receive shoulder block Sample size justification Sample size was&#xD;
        calculated using Power Analysis and Sample Size software program (PASS) version 11.0.4 for&#xD;
        windows (2011) with time to first analgesic request as the primary outcome. Using the results&#xD;
        published by Pani et al 2019 (8) with the mean time to first analgesic request in shoulder&#xD;
        block group was (5.9 ± 1.2 hours) Using a two-sided two-sample unequal-variance t-test,&#xD;
        sample size of 42 patients is needed to achieve 95% power to detect 20 % difference in time&#xD;
        to first analgesic request. Using a two-sided hypothesis test with a significance level of&#xD;
        0.05.&#xD;
  &#xD;
        Anticipated Results The application of pericapsular nerve group block in patients undergoing&#xD;
        elective shoulder arthroscopic surgeries may improve management of their perioperative pain.&#xD;
  &#xD;
        Randomization:&#xD;
  &#xD;
        The study subjects will be randomized by using block randomization using sealed concealed&#xD;
        envelopes into two groups.&#xD;
  &#xD;
        Data collection:&#xD;
  &#xD;
        The patients will be observed or 24 hours postoperatively by a blinded investigator for the&#xD;
        given block. All patients will receive one gram acetaminophen intravenously every 8 hours as&#xD;
        apart o multimodal analgesia protocol.&#xD;
  &#xD;
        Primary outcome will be the duration of analgesia (time to first rescue analgesia after&#xD;
        administration of the block). Postoperative pain will be assessed using 100 mm vertical&#xD;
        visual analogue score (VAS). The pain score will be recorded at 0, 1, 4, 8, 12, and 24 hours&#xD;
        at rest (VASr) and movement (VASm). Morphine will be given intravenously if VASr, VASm or&#xD;
        both exceeds 30mm in one milligram allequate with 5 minutes intervals till VAS be less than&#xD;
        30 mm or exceeding safety dose of 30 mg in 4 hours.&#xD;
  &#xD;
        Secondary outcomes:&#xD;
  &#xD;
        Total fentanyl consumptions as a rescue analgesia intaoperatively. Total morphine consumption&#xD;
        in 24 hours postoperatively. Intraoperative hemodynamics mean arterial pressure and mean&#xD;
        heart rate. length of stay in hospital Ability to perform physical rehabilitation program in&#xD;
        the first 24 hours postoperatively.&#xD;
  &#xD;
        postoperative sedation score using Ramsey score patient satisfaction will be assessed by&#xD;
        numerical score (1= very dissatisfied, 2= dissatisfied, 3=neither satisfied or dissatisfied,&#xD;
        4= satisfied, 5=very satisfied) postoperative nausea and vomiting (PONV) will be assessed&#xD;
        using four points numerical score (0=no PONV, 1= mild nausea , 2= severe nausea or vomiting&#xD;
        once, 3= vomiting more than once)&#xD;
  &#xD;
        End point:&#xD;
  &#xD;
        The observation of patients will be finished 24 hours posoperatively.&#xD;
  &#xD;
        Results:&#xD;
  &#xD;
        It will be recorded and analyzed statistically.&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Not yet recruiting</overall_status>
    <start_date type="Anticipated">August 1, 2023</start_date>
    <completion_date type="Anticipated">March 1, 2024</completion_date>
    <primary_completion_date type="Anticipated">February 1, 2024</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Randomized</allocation>
      <intervention_model>Parallel Assignment</intervention_model>
      <primary_purpose>Treatment</primary_purpose>
      <masking>Double (Investigator, Outcomes Assessor)</masking>
      <masking_description>The block will be performed by one investigator who is not participating in either data collection or analysis. Also the patient will be blinded .</masking_description>
    </study_design_info>
    <primary_outcome>
      <measure>Duration of analgesia (time to first rescue analgesia) minutes</measure>
      <time_frame>24 hours after surgery</time_frame>
      <description>Postoperative pain will be assessed using 100 millimeter vertical visual analog score (VAS) where (1-3) no pain, &gt;3- 6) mild pain, and (&gt;6 severe pain). The pain score will be recorded at 0, 1, 4, 8, 12, and 24 hours at rest (VASr) and movement (VASm). Morphine will be given intravenously if VASr, VASm, or both exceed 30mm in one milligram adequate with 5 minutes intervals till VAS be less than 30 mm or exceeds the safety dose of 30 mg in 4 hours.</description>
    </primary_outcome>
    <secondary_outcome>
      <measure>Total morphine consumption milligrams</measure>
      <time_frame>24 hours after surgery</time_frame>
      <description>Total morphine consumption in 24 hours postoperatively.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Total fentanyl consumptions microgram</measure>
      <time_frame>Intraoperative period</time_frame>
      <description>Total fentanyl consumptions as a rescue analgesia intaoperatively</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>intraoperative hemodynamics</measure>
      <time_frame>Intraoperative period</time_frame>
      <description>Mean arterial blood pressure millimeter mercury , mean heart rate beat per minute</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>length of stay in hospital hours</measure>
      <time_frame>24 hours postoperative</time_frame>
      <description>length of stay in hospital after surgery by hours</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>postoperative sedation</measure>
      <time_frame>Immediate postoperative period</time_frame>
      <description>Ramsey sedation Score</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>patient satisfaction</measure>
      <time_frame>24 hours postoperative</time_frame>
      <description>numerical score (1= very dissatisfied, 2= dissatisfied, 3=neither satisfied or dissatisfied, 4= satisfied, 5=very satisfied)</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>postoperative nausea and vomiting (PONV)</measure>
      <time_frame>24 hours postoperative</time_frame>
      <description>four points numerical score (0=no PONV, 1= mild nausea , 2= severe nausea or vomiting once, 3= vomiting more than once)</description>
    </secondary_outcome>
    <number_of_arms>2</number_of_arms>
    <enrollment type="Anticipated">50</enrollment>
    <condition>Efficacy of PENG Block Managing Perioperative Pain With Shoulder Arthroscopy Surgeries</condition>
    <condition>Efficacy of Shoulder Block in Managing Perioperative Pain With Shoulder Arthroscopy Surgeries</condition>
    <arm_group>
      <arm_group_label>Shoulder PENG block group</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>Ultrasound-guided peri-capsular nerve block of the shoulder with 20ml of 0.25% bupivacaine between the supraspinatus muscle and deltoid muscle.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Shoulder block</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>ultrasound guided axillary nerve block and suprascapular nerve block posterior approach with 10 ml 0.25% bupivacaine (total 20ml)</description>
    </arm_group>
    <intervention>
      <intervention_type>Procedure</intervention_type>
      <intervention_name>Shoulder PENG block</intervention_name>
      <description>Ultrasound guided insertion of a needle between subscapularis tendon and deltoid with injection of 10 mi 0.25% bupivacaine after confirming right plane of injection</description>
      <arm_group_label>Shoulder PENG block group</arm_group_label>
      <arm_group_label>Shoulder block</arm_group_label>
      <other_name>Shoulder Block</other_name>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            -  ASA I - II&#xD;
  &#xD;
            -  Age between 18 - 60&#xD;
  &#xD;
            -  unilateral elective shoulder arthroscopic surgery&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
            -  Patient refusal&#xD;
  &#xD;
            -  Altered mental status or un-cooperative patients&#xD;
  &#xD;
            -  Hypersensitivity to local anesthetics&#xD;
  &#xD;
            -  Bleeding disorders&#xD;
  &#xD;
            -  receiving antiplatelet or anticoagulant drugs&#xD;
  &#xD;
            -  local infection at the site of local injection&#xD;
  &#xD;
            -  Intra articular infections&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>18 Years</minimum_age>
      <maximum_age>60 Years</maximum_age>
      <healthy_volunteers>No</healthy_volunteers>
    </eligibility>
    <overall_contact>
      <last_name>Kareem Mohamed Mikhamer, MD</last_name>
      <phone>00201212231227</phone>
      <email>kareemmikhamer@gmail.com</email>
    </overall_contact>
    <reference>
      <citation>Rockwood CA Jr. Shoulder arthroscopy. J Bone Joint Surg Am. 1988 Jun;70(5):639-40. No abstract available.</citation>
      <PMID>3392055</PMID>
    </reference>
    <reference>
      <citation>Severud EL, Ruotolo C, Abbott DD, Nottage WM. All-arthroscopic versus mini-open rotator cuff repair: A long-term retrospective outcome comparison. Arthroscopy. 2003 Mar;19(3):234-8. doi: 10.1053/jars.2003.50036.</citation>
      <PMID>12627146</PMID>
    </reference>
    <reference>
      <citation>Farmer KW, Wright TW. Shoulder arthroscopy: the basics. J Hand Surg Am. 2015 Apr;40(4):817-21. doi: 10.1016/j.jhsa.2015.01.002. Epub 2015 Feb 26.</citation>
      <PMID>25726045</PMID>
    </reference>
    <reference>
      <citation>Tran DQ, Elgueta MF, Aliste J, Finlayson RJ. Diaphragm-Sparing Nerve Blocks for Shoulder Surgery. Reg Anesth Pain Med. 2017 Jan/Feb;42(1):32-38. doi: 10.1097/AAP.0000000000000529.</citation>
      <PMID>27941477</PMID>
    </reference>
    <reference>
      <citation>Neuts A, Stessel B, Wouters PF, Dierickx C, Cools W, Ory JP, Dubois J, Jamaer L, Arijs I, Schoorens D. Selective Suprascapular and Axillary Nerve Block Versus Interscalene Plexus Block for Pain Control After Arthroscopic Shoulder Surgery: A Noninferiority Randomized Parallel-Controlled Clinical Trial. Reg Anesth Pain Med. 2018 Oct;43(7):738-744. doi: 10.1097/AAP.0000000000000777.</citation>
      <PMID>29659438</PMID>
    </reference>
    <reference>
      <citation>Tran J, Peng PWH, Agur AMR. Anatomical study of the innervation of glenohumeral and acromioclavicular joint capsules: implications for image-guided intervention. Reg Anesth Pain Med. 2019 Jan 11:rapm-2018-100152. doi: 10.1136/rapm-2018-100152. Online ahead of print.</citation>
      <PMID>30635516</PMID>
    </reference>
    <reference>
      <citation>Kupeli I, Yazici Kara M. Anesthesia or analgesia? New block for shoulder surgery: pericapsular nerve group block. Braz J Anesthesiol. 2022 Sep-Oct;72(5):669-672. doi: 10.1016/j.bjane.2021.05.009. Epub 2021 Jun 9.</citation>
      <PMID>34118263</PMID>
    </reference>
    <reference>
      <citation>Pani N, Routray SS, Pani S, Mallik S, Pattnaik S, Pradhan A. Post-operative analgesia for shoulder arthroscopic surgeries: A comparison between inter-scalene block and shoulder block. Indian J Anaesth. 2019 May;63(5):382-387. doi: 10.4103/ija.IJA_65_19.</citation>
      <PMID>31142882</PMID>
    </reference>
    <results_reference>
      <citation>Grosh T, Elkassabany NM. Enhanced Recovery After Shoulder Arthroplasty. Anesthesiol Clin. 2018 Sep;36(3):417-430. doi: 10.1016/j.anclin.2018.04.006.</citation>
      <PMID>30092938</PMID>
    </results_reference>
    <verification_date>August 2023</verification_date>
    <study_first_submitted>July 28, 2023</study_first_submitted>
    <study_first_submitted_qc>August 8, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">August 9, 2023</study_first_posted>
    <last_update_submitted>August 8, 2023</last_update_submitted>
    <last_update_submitted_qc>August 8, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">August 9, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Principal Investigator</responsible_party_type>
      <investigator_affiliation>General Committee of Teaching Hospitals and Institutes, Egypt</investigator_affiliation>
      <investigator_full_name>Kareem Mikhamer</investigator_full_name>
      <investigator_title>Fellow lecturer of Anaesthesia</investigator_title>
    </responsible_party>
    <patient_data>
      <sharing_ipd>No</sharing_ipd>
    </patient_data>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT05982951
  org study id: GeneralCTHI
  nct id: NCT05982951
  lead sponsor: 
  is fda regulated drug: No
  is fda regulated device: No
  Shoulder arthroscopic surgeries are one of the most common procedures performed on a daily
        basis in our practice. The arthroscopic techniques offer a lesser invasive option as Open
        repair does not offer a significantly better 2-year result in terms of stability, and
        furthermore, can negatively affect the recovery of the full range of motion of the shoulder.
        Open techniques Shoulder procedures are performed arthroscopically nowadays with fewer
        complications compared with open surgery.
  
        Indications of shoulder arthroscopy are expanding and include biceps tears, labral tears,
        rotator muscles tears, subacromial impingements chondral injuries, loose bodies, early
        degenerative changes, adhesive capsulitis, shoulder instability and acromioclavicular
        osteoarthritis.
  
        There are many regional anesthetic techniques used to control perioperative pain during
        arthroscopic procedures. Interscalene block results in effective shoulder surgery analgesia,
        but it is associated with various complications such as diaphragmatic paralysis due to the
        high incidence of phrenic nerve block.
  
        The suprascapular nerve block combined with the axillary nerve block is non-inferior to
        conventional inter-scalene block except for the early recovery period with the advantage of
        lower incidence of dyspnea and discomfort.
  
        . In a cadaveric anatomical study that the posterosuperior quadrant and the posteroinferior
        quadrant of the GHJ were innervated by the suprascapular nerve and the axillary nerve
        respectively. While the anterosuperior quadrant portion of the joint is sensory supplied by
        the subscapularis superior branch and the anteroinferior by the main branch of the axillary
        nerve. These anatomical data the possibility of a new block targeting the GHJ sensory
        branches. It was suggested that deep pericapsular infiltration of local anesthetic towards
        the subscapularis may cover the axillary and subscapularis branches that feed the
        anteroinferior and superior quadrants of the GHJ.
  
        Recently, the pericapsular nerve group block of the shoulder joint as described in a case
        series including two cases underwent a humeral neck fracture fixation and Bankart
        arthroscopic repair with promising anesthesia and analgesia in selected shoulder surgeries.
  anesthetics Bleeding disorders receiving antiplatelet or anticoagulant drugs local infection
        at site of local injection Intra articular infections
  
        Sample size and methodology:
  
        WE will enroll 42 patient undergoing elective shoulder arthroscopy. They will be randomized
        and allocated into two groups; Group A and group B. Group A will receive ultrasound guided
        PENG block and group B will receive shoulder block Sample size justification Sample size was
        calculated using Power Analysis and Sample Size software program (PASS) version 11.0.4 for
        windows (2011) with time to first analgesic request as the primary outcome. Using the results
        published by Pani et al 2019 (8) with the mean time to first analgesic request in shoulder
        block group was (5.9 ± 1.2 hours) Using a two-sided two-sample unequal-variance t-test,
        sample size of 42 patients is needed to achieve 95% power to detect 20 % difference in time
        to first analgesic request. Using a two-sided hypothesis test with a significance level of
        0.05.
  
        Anticipated Results The application of pericapsular nerve group block in patients undergoing
        elective shoulder arthroscopic surgeries may improve management of their perioperative pain.
  
        Randomization:
  
        The study subjects will be randomized by using block randomization using sealed concealed
        envelopes into two groups.
  
        Data collection:
  
        The patients will be observed or 24 hours postoperatively by a blinded investigator for the
        given block. All patients will receive one gram acetaminophen intravenously every 8 hours as
        apart o multimodal analgesia protocol.
  
        Primary outcome will be the duration of analgesia (time to first rescue analgesia after
        administration of the block). Postoperative pain will be assessed using 100 mm vertical
        visual analogue score (VAS). The pain score will be recorded at 0, 1, 4, 8, 12, and 24 hours
        at rest (VASr) and movement (VASm). Morphine will be given intravenously if VASr, VASm or
        both exceeds 30mm in one milligram allequate with 5 minutes intervals till VAS be less than
        30 mm or exceeding safety dose of 30 mg in 4 hours.
  
        Secondary outcomes:
  
        Total fentanyl consumptions as a rescue analgesia intaoperatively. Total morphine consumption
        in 24 hours postoperatively. Intraoperative hemodynamics mean arterial pressure and mean
        heart rate. length of stay in hospital Ability to perform physical rehabilitation program in
        the first 24 hours postoperatively.
  
        postoperative sedation score using Ramsey score patient satisfaction will be assessed by
        numerical score (1= very dissatisfied, 2= dissatisfied, 3=neither satisfied or dissatisfied,
        4= satisfied, 5=very satisfied) postoperative nausea and vomiting (PONV) will be assessed
        using four points numerical score (0=no PONV, 1= mild nausea , 2= severe nausea or vomiting
        once, 3= vomiting more than once)
  
        End point:
  
        The observation of patients will be finished 24 hours posoperatively.
  
        Results:
  
        It will be recorded and analyzed statistically.
  allocation: Randomized
  intervention model: Parallel Assignment
  primary purpose: Treatment
  masking: Double (Investigator, Outcomes Assessor)
  masking description: The block will be performed by one investigator who is not participating in either data collection or analysis. Also the patient will be blinded .
  measure: Duration of analgesia (time to first rescue analgesia) minutes
  time frame: 24 hours after surgery
  description: Postoperative pain will be assessed using 100 millimeter vertical visual analog score (VAS) where (1-3) no pain, >3- 6) mild pain, and (>6 severe pain). The pain score will be recorded at 0, 1, 4, 8, 12, and 24 hours at rest (VASr) and movement (VASm). Morphine will be given intravenously if VASr, VASm, or both exceed 30mm in one milligram adequate with 5 minutes intervals till VAS be less than 30 mm or exceeds the safety dose of 30 mg in 4 hours.
  measure: Total morphine consumption milligrams
  time frame: 24 hours after surgery
  description: Total morphine consumption in 24 hours postoperatively.
  measure: Total fentanyl consumptions microgram
  time frame: Intraoperative period
  description: Total fentanyl consumptions as a rescue analgesia intaoperatively
  measure: intraoperative hemodynamics
  time frame: Intraoperative period
  description: Mean arterial blood pressure millimeter mercury , mean heart rate beat per minute
  measure: length of stay in hospital hours
  time frame: 24 hours postoperative
  description: length of stay in hospital after surgery by hours
  measure: postoperative sedation
  time frame: Immediate postoperative period
  description: Ramsey sedation Score
  measure: patient satisfaction
  time frame: 24 hours postoperative
  description: numerical score (1= very dissatisfied, 2= dissatisfied, 3=neither satisfied or dissatisfied, 4= satisfied, 5=very satisfied)
  measure: postoperative nausea and vomiting (PONV)
  time frame: 24 hours postoperative
  description: four points numerical score (0=no PONV, 1= mild nausea , 2= severe nausea or vomiting once, 3= vomiting more than once)
  arm group label: Shoulder PENG block group
  arm group type: Active Comparator
  description: Ultrasound-guided peri-capsular nerve block of the shoulder with 20ml of 0.25% bupivacaine between the supraspinatus muscle and deltoid muscle.
  arm group label: Shoulder block
  arm group type: Active Comparator
  description: ultrasound guided axillary nerve block and suprascapular nerve block posterior approach with 10 ml 0.25% bupivacaine (total 20ml)
  intervention type: Procedure
  intervention name: Shoulder PENG block
  description: Ultrasound guided insertion of a needle between subscapularis tendon and deltoid with injection of 10 mi 0.25% bupivacaine after confirming right plane of injection
  arm group label: Shoulder PENG block group
  arm group label: Shoulder block
  other name: Shoulder Block
  criteria: 
  gender: All
  minimum age: 18 Years
  maximum age: 60 Years
  healthy volunteers: No
  last name: Kareem Mohamed Mikhamer, MD
  phone: 00201212231227
  email: kareemmikhamer@gmail.com
  citation: Rockwood CA Jr. Shoulder arthroscopy. J Bone Joint Surg Am. 1988 Jun;70(5):639-40. No abstract available.
  PMID: 3392055
  citation: Severud EL, Ruotolo C, Abbott DD, Nottage WM. All-arthroscopic versus mini-open rotator cuff repair: A long-term retrospective outcome comparison. Arthroscopy. 2003 Mar;19(3):234-8. doi: 10.1053/jars.2003.50036.
  PMID: 12627146
  citation: Farmer KW, Wright TW. Shoulder arthroscopy: the basics. J Hand Surg Am. 2015 Apr;40(4):817-21. doi: 10.1016/j.jhsa.2015.01.002. Epub 2015 Feb 26.
  PMID: 25726045
  citation: Tran DQ, Elgueta MF, Aliste J, Finlayson RJ. Diaphragm-Sparing Nerve Blocks for Shoulder Surgery. Reg Anesth Pain Med. 2017 Jan/Feb;42(1):32-38. doi: 10.1097/AAP.0000000000000529.
  PMID: 27941477
  citation: Neuts A, Stessel B, Wouters PF, Dierickx C, Cools W, Ory JP, Dubois J, Jamaer L, Arijs I, Schoorens D. Selective Suprascapular and Axillary Nerve Block Versus Interscalene Plexus Block for Pain Control After Arthroscopic Shoulder Surgery: A Noninferiority Randomized Parallel-Controlled Clinical Trial. Reg Anesth Pain Med. 2018 Oct;43(7):738-744. doi: 10.1097/AAP.0000000000000777.
  PMID: 29659438
  citation: Tran J, Peng PWH, Agur AMR. Anatomical study of the innervation of glenohumeral and acromioclavicular joint capsules: implications for image-guided intervention. Reg Anesth Pain Med. 2019 Jan 11:rapm-2018-100152. doi: 10.1136/rapm-2018-100152. Online ahead of print.
  PMID: 30635516
  citation: Kupeli I, Yazici Kara M. Anesthesia or analgesia? New block for shoulder surgery: pericapsular nerve group block. Braz J Anesthesiol. 2022 Sep-Oct;72(5):669-672. doi: 10.1016/j.bjane.2021.05.009. Epub 2021 Jun 9.
  PMID: 34118263
  citation: Pani N, Routray SS, Pani S, Mallik S, Pattnaik S, Pradhan A. Post-operative analgesia for shoulder arthroscopic surgeries: A comparison between inter-scalene block and shoulder block. Indian J Anaesth. 2019 May;63(5):382-387. doi: 10.4103/ija.IJA_65_19.
  PMID: 31142882
  citation: Grosh T, Elkassabany NM. Enhanced Recovery After Shoulder Arthroplasty. Anesthesiol Clin. 2018 Sep;36(3):417-430. doi: 10.1016/j.anclin.2018.04.006.
  PMID: 30092938
  responsible party type: Principal Investigator
  investigator affiliation: General Committee of Teaching Hospitals and Institutes, Egypt
  investigator full name: Kareem Mikhamer
  investigator title: Fellow lecturer of Anaesthesia
  sharing ipd: No