Combined regional anesthesia versus general anesthesia for elective shoulder arthroscopy: a prospective randomized trial of postoperative pain, with an exploratory cost analysis.
5 affiliations
- 1Department of Anesthesiology and Reanimation, Ankara Etlik City Hospital, Varlık Neighborhood, Halil Sezai Erkut Street, Ankara, 06170, Turkey. [email protected].
- 2Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Etlik City Hospital, Ankara, Turkey.
- 3Department of Orthopedics and Traumatology, University of Health Sciences, Ankara Etlik City Hospital, Ankara, Turkey.
- 4Department of Anesthesiology and Reanimation, Dokuz Eylul University Faculty of Medicine, Ankara, Turkey.
- 5Department of Anesthesiology and Reanimation, Ankara Etlik City Hospital, Varlık Neighborhood, Halil Sezai Erkut Street, Ankara, 06170, Turkey.
Abstract
Background
Shoulder arthroscopy causes substantial postoperative pain and operating room resource use. Randomized trials integrating postoperative pain trajectory with sensitivity-tested cost analysis are limited. We compared combined three-block regional anesthesia with standard general anesthesia in elective shoulder arthroscopy.Methods
In this prospective, randomized, parallel-group, single-center trial, 50 adults undergoing elective shoulder arthroscopy in the beach-chair position were allocated 1:1 to ultrasound-guided combined interscalene, supraclavicular, and superficial cervical plexus blocks with dexmedetomidine sedation or standard general anesthesia. The primary outcome was the resting Numeric Rating Scale (NRS, 0-10) pain score at 4 h. Pre-specified secondary outcomes included pain scores at the remaining timepoints, movement-evoked pain, patient and surgeon satisfaction, surgical duration, and intraoperative opioid consumption. Exploratory post-hoc outcomes included cumulative pain burden (area under the NRS-time curve), total perioperative cost, hemodynamic parameters, perioperative time components, rescue analgesia, postoperative nausea and vomiting, and complications.Results
Resting NRS at 4 h was lower with regional anesthesia than with general anesthesia (median 0 [IQR 0-0] vs. 4 [IQR 3-5]; Hodges-Lehmann median difference 4 points, 95% CI 3 to 4; p < 0.001) and remained lower through the 4-hour timepoint. Movement NRS increased at 12 and 24 h after block regression. Among the pre-specified secondary outcomes, patient and surgeon satisfaction was higher with regional anesthesia, while surgical duration was similar. In exploratory post-hoc analyses, the 24-hour cumulative pain burden was lower with regional anesthesia, total perioperative cost was approximately 38% lower with regional anesthesia across all sensitivity scenarios, total operating room time was shorter, and complication types differed qualitatively between groups with no significant difference in incidence detected.Conclusions
Combined regional anesthesia provided superior early analgesia and greater patient and surgeon satisfaction than general anesthesia. Exploratory post-hoc analyses suggested lower 24-hour cumulative pain burden, lower total perioperative cost and shorter operating room utilization. These economic and operational findings should be considered hypothesis-generating.Trial registration
Clinicaltrials Registration No: NCT06674954, Date: October 16, 2024.
Related
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BibTeX
@article{sezgi2026combined,
title = {{Combined regional anesthesia versus general anesthesia for elective shoulder arthroscopy: a prospective randomized trial of postoperative pain, with an exploratory cost analysis.}},
author = {Atakan Sezgi and Musa Zengin and Mehmet Faruk Çatma and Onur Küçük and İbrahim Topcu and Mürüvvet Taşkır Turan and Yusuf Özgüner and Ekin Güran Aytuğ and Fethi Gültop and Jülide Ergil},
journal = {BMC surgery},
year = {2026},
month = aug,
doi = {10.1186/s12893-026-04109-2},
url = {https://europepmc.org/article/MED/42958194},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Combined regional anesthesia versus general anesthesia for elective shoulder arthroscopy: a prospective randomized trial of postoperative pain, with an exploratory cost analysis.
AU - Atakan Sezgi
AU - Musa Zengin
AU - Mehmet Faruk Çatma
AU - Onur Küçük
AU - İbrahim Topcu
AU - Mürüvvet Taşkır Turan
AU - Yusuf Özgüner
AU - Ekin Güran Aytuğ
AU - Fethi Gültop
AU - Jülide Ergil
PY - 2026
DA - 2026/08/04
JO - BMC surgery
DO - 10.1186/s12893-026-04109-2
UR - https://europepmc.org/article/MED/42958194
AB - Background Shoulder arthroscopy causes substantial postoperative pain and operating room resource use. Randomized trials integrating postoperative pain trajectory with sensitivity-tested cost analysis are limited. We compared combined three-block regional anesthesia with standard general anesthesia in elective shoulder arthroscopy.Methods In this prospective, randomized, parallel-group, single-center trial, 50 adults undergoing elective shoulder arthroscopy in the beach-chair position were allocated 1:1 to ultrasound-guided combined interscalene, supraclavicular, and superficial cervical plexus blocks with dexmedetomidine sedation or standard general anesthesia. The primary outcome was the resting Numeric Rating Scale (NRS, 0-10) pain score at 4 h. Pre-specified secondary outcomes included pain scores at the remaining timepoints, movement-evoked pain, patient and surgeon satisfaction, surgical duration, and intraoperative opioid consumption. Exploratory post-hoc outcomes included cumulative pain burden (area under the NRS-time curve), total perioperative cost, hemodynamic parameters, perioperative time components, rescue analgesia, postoperative nausea and vomiting, and complications.Results Resting NRS at 4 h was lower with regional anesthesia than with general anesthesia (median 0 [IQR 0-0] vs. 4 [IQR 3-5]; Hodges-Lehmann median difference 4 points, 95% CI 3 to 4; p < 0.001) and remained lower through the 4-hour timepoint. Movement NRS increased at 12 and 24 h after block regression. Among the pre-specified secondary outcomes, patient and surgeon satisfaction was higher with regional anesthesia, while surgical duration was similar. In exploratory post-hoc analyses, the 24-hour cumulative pain burden was lower with regional anesthesia, total perioperative cost was approximately 38% lower with regional anesthesia across all sensitivity scenarios, total operating room time was shorter, and complication types differed qualitatively between groups with no significant difference in incidence detected.Conclusions Combined regional anesthesia provided superior early analgesia and greater patient and surgeon satisfaction than general anesthesia. Exploratory post-hoc analyses suggested lower 24-hour cumulative pain burden, lower total perioperative cost and shorter operating room utilization. These economic and operational findings should be considered hypothesis-generating.Trial registration Clinicaltrials Registration No: NCT06674954, Date: October 16, 2024.
SN - 1471-2482
ER -