Institutional Review Board, Hospital for Special Surgery
January 14, 2008
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The purpose of this study is to formally compare the effectiveness of two ultrasound guided anesthetic techniques in the setting of shoulder surgery: the supraclavicular versus the interscalene block. Both techniques are safe and in our experience, provide adequate anesthesia for shoulder surgery and good postoperative pain relief. Furthermore, the ultrasound allows us to visualize and locate the nerves.
The interscalene block is a more established technique and has been used routinely for shoulder surgery. It is also more associated with three well known, but short-lived, side effects than the supraclavicular technique. These side effects are: 1) temporary hoarseness or an alteration in the quality of your voice, 2) temporary hemidiaphragmatic paresis or inability to breathe deeply on the side of the block due to part of your diaphragm not moving normally and 3) Horner’s syndrome, a group of two temporary physical signs on the side of the block (eyelid droop and constriction of the pupil of the eye).
We believe these side effects occur less frequently with the newer supraclavicular technique.
Hence we propose a double-blinded randomized control trial. 60 patients undergoing ambulatory shoulder surgery within a one year period will be randomized to receive either an ultrasound guided supraclavicular brachial plexus block or an ultrasound guided interscalene brachial plexus block. A blinded research assistant will take the following information in the holding area before surgery and after the patient enters the recovery room: a close up digital photograph of the patient’s eyes (lower part of face hidden by a study folder), a test of the patient’s gag reflex and an audio recording of the patient reading a short text. In the operating room, at 5 and 10 minutes after placement of the block, the blinded research assistant will assess the progressive loss of sensation and motor function. Finally, to assess the block’s effect on diaphragm movement, an ultrasound image of the ultrasound will be taken before surgery and after placement of the block.
• Age 18 – 80
• Patients at the Hospital for Special Surgery undergoing shoulder surgery.
• Patients with documented evidence of preoperative hemidiaphragmatic paresis (ie on CXR)
• Patients with preoperative hoarseness.
• Patients with preoperative ptosis
• Patients with preoperative brachial plexopathy
• Patients with a perceived need for a long acting anesthetic, such that the local anesthetic agents described in the study protocol would not be appropriate.
• Contraindication to regional blockade (local cellulitis, coagulopathy, allergy to local anesthetic agents).
• Patients undergoing total shoulder joint replacement surgery.
Dorothy Marcello, BA