Due to diaphragmatic paralysis, interscalene block (ISB) application is contraindicated
in patients with pulmonary issues, leaving general anesthesia as the only option.
However, the use of opioids for postoperative analgesia in such patients brings unwanted
opioid side effects. Consequently, new approaches have emerged to prevent diaphragmatic
paralysis, making peripheral blocks feasible for shoulder arthroscopies in patients with
pulmonary problems. This study aims to reassess the hypothesis regarding ISB and superior
trunk block (STB), routinely used for shoulder arthroscopy surgery, in patients without
pulmonary issues, supported by simultaneous ultrasound measurements of diaphragmatic
excursion and spirometry measurements of respiratory function. Additionally, the
demographic characteristics of patients, onset time of block effects, postoperative
additional analgesic requirements, durations of block effects, and times of initial
analgesic needs will be observed and compared.
Research Type Description: The study is prospective randomized research. Respiratory
function measurements will be taken from patients undergoing ISB and STB, which are
routinely performed in brachial plexus blocks in our clinic. These measurements do not
involve any invasive procedures and will be solely quantitatively assessed using
ultrasound and respiratory function tests.
Case Report Form: The form that will be used is a case report form. Each participant will
be assigned a unique number, and all sections related to the study will be completed for
each participant.
Data Collection:
After obtaining consent from patients agreeing to participate in the study, patients will
be monitored (blood pressure, heart rate, oxygen saturation), and intravenous access will
be established.
Dr. Beyza Mehri Büyükgebiz Yeşil will measure diaphragmatic excursion under ultrasound
guidance during deep and normal respiration on the side where the block will be performed
and record the values in the case report form.
Dr. Beyza Mehri Büyükgebiz Yeşil will perform respiratory function testing with a
spirometer and record the values in the case report form.
The blocks will be administered by Assoc Prof Dr. Gökçen Emmez and Prof Dr. İrfan Güngör.
Thirty minutes after the end of the block application, Dr. Beyza Mehri Büyükgebiz Yeşil
will measure diaphragmatic excursion under ultrasound guidance during deep and normal
respiration on the side where the block was performed and perform respiratory function
testing with a spirometer and record the values in the case report form.
Blinding of the study will be ensured by having different researchers perform the block
and measurements.
Prof Ulunay Kanatlı will perform the surgical procedure. Patients will be prescribed 3X1
grams of Paracetamol for routine postoperative analgesia.
The onset time of the block effect, postoperative additional analgesic requirements,
duration of block effects, and time of initial analgesic needs will be observed and
recorded in the case report form.
Both surgeon and patient satisfaction will be recorded in the case report form at the end
of surgery. Patients will be contacted by phone one week after discharge to inquire about
their current condition.
Data Analysis:
At the end of the study, data will be evaluated via case report forms and interpreted
using appropriate statistical methods.
Diaphragmatic excursion change rates will be interpreted and analyzed by Prof. Dr. İrfan
Güngör and Prof. Dr. Berrin Günaydın, and respiratory function values from the spirometer
will be interpreted and analyzed by Prof. Dr. İpek Kıvılcım Oğuzülgen.
If continuous variables follow a normal distribution, the Student's T-test will be
applied; if they do not follow a normal distribution, the Mann-Whitney U test will be
applied. The Chi-square test will be applied to compare ratios. Depending on whether the
data follows a normal distribution or not, Spearman or Pearson correlation tests will be
applied for correlation evaluation. A p value of less than 0.05 will be considered
statistically significant. Data will be presented as mean ± standard deviation, median,
and n.
