Postoperative PainSPENG-RCTNCT07762417
SPENG Block Versus Suprascapular and Axillary Nerve Blocks for Pain After Shoulder Arthroscopy
A study testing Shoulder Posterior Pericapsular Nerve Group (SPENG) Block and Combined Posterior Suprascapular and Axillary Nerve Blocks in people with Postoperative Pain and Shoulder Arthroscopy, run by Izmir City Hospital.
Trial summary
This prospective, randomized, patient- and assessor-blinded, single-center non-inferiority trial will compare the analgesic efficacy of the Shoulder Posterior Pericapsular Nerve Group (SPENG) block with combined posterior suprascapular and axillary nerve blocks in adults undergoing elective shoulder arthroscopy under… Read more about this study
- Who is it for?
- Ages 18 to 70 years
- Conditions the study is for
- Postoperative Pain, Shoulder Arthroscopy
- What is being tested?
- Shoulder Posterior Pericapsular Nerve Group (SPENG) Block and Combined Posterior Suprascapular and Axillary Nerve Blocks
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- No sites listed yet
- Study dates
- 1 Nov 2026to 15 Jun 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 70 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age 18 to 70 years
- American Society of Anesthesiologists (ASA) physical status I-III
- Scheduled to undergo elective shoulder arthroscopy under general anesthesia
- Able to understand the Numeric Rating Scale for pain assessment
- Able and willing to provide written informed consent
Who cannot join
- Known allergy or hypersensitivity to local anesthetics used in the study
- Infection at the planned block injection site
- Coagulopathy or ongoing anticoagulant therapy that cannot be appropriately interrupted for peripheral nerve block
- Pre-existing neurological deficit affecting the operative upper extremity
- Moderate or severe pulmonary disease
- Known diaphragmatic dysfunction
Show all 12Show fewer
- Chronic opioid use
- Chronic pain syndrome
- Body mass index greater than 35 kg/m²
- Pregnancy or breastfeeding
- Inability to understand or reliably report Numeric Rating Scale pain scores
- Inadequate sonographic window preventing safe performance of the allocated block technique before randomization
Trial locations and contacts
No sites are listed yet. Contact the study team or a site near you to ask about taking part.
About this study
Official title: Analgesic Efficacy of the Shoulder Posterior Pericapsular Nerve Group Block Versus Combined Posterior Suprascapular and Axillary Nerve Blocks for Shoulder Arthroscopy: A Randomized, Blinded, Non-Inferiority Trial
This prospective, randomized, patient- and assessor-blinded, single-center non-inferiority trial will compare the analgesic efficacy of the Shoulder Posterior Pericapsular Nerve Group (SPENG) block with combined posterior suprascapular and axillary nerve blocks in adults undergoing elective shoulder arthroscopy under general anesthesia. Both groups will receive the same total volume and concentration of local anesthetic. The primary outcome will be the highest resting Numeric Rating Scale pain score recorded during the first 24 postoperative hours. Secondary outcomes will include block performance time, sensory block success in suprascapular and axillary nerve territories, opioid consumption, time to rescue analgesia, motor function, diaphragmatic function, postoperative recovery quality, patient satisfaction, and block-related complications.
- Conditions
- Postoperative Pain, Shoulder Arthroscopy
- Being tested
- Shoulder Posterior Pericapsular Nerve Group (SPENG) Block, Combined Posterior Suprascapular and Axillary Nerve Blocks
- Keywords
- Diaphragm-sparing block, Postoperative analgesia, Regional anesthesia, Axillary nerve block, Suprascapular nerve block, Shoulder arthroscopy, Shoulder Posterior Pericapsular Nerve Group block, SPENG block
- Medical subject headings
- Pain, Postoperative
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Shoulder Posterior Pericapsular Nerve Group (SPENG) BlockProcedure or surgery
Also called SPENG Block
An ultrasound-guided single-injection posterior pericapsular block. With the participant in the lateral decubitus position and the operative shoulder uppermost, a high-frequency linear ultrasound transducer will be placed transversely immediately inferior to the posterior acromion. After identification of the humeral head, articular cartilage, infraspinatus muscle, and posterior glenoid rim, a block needle will be advanced in-plane in a medial-to-lateral direction. The needle tip will be positioned between the posterior glenoid rim and the deep surface of the infraspinatus muscle, and 20 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be injected.
Combined Posterior Suprascapular and Axillary Nerve BlocksProcedure or surgery
Also called Posterior Shoulder Block
wo ultrasound-guided nerve blocks will be performed. For the posterior suprascapular nerve block, the suprascapular nerve will be identified in the suprascapular notch region beneath the supraspinatus muscle, and 10 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be administered. For the axillary nerve block, the posterior humeral circumflex artery will be identified using color Doppler in the quadrilateral space, and 10 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be administered adjacent to the axillary nerve.
| Study group | Role | What they receive |
|---|---|---|
| SPENG Block | Experimental | Participants assigned to this group will receive an ultrasound-guided Shoulder Posterior Pericapsular Nerve Group (SPENG) block before general anesthesia for shoulder arthroscopy. A total of 20 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be administered as a single injection between the posterior glenoid rim and the deep surface of the infraspinatus muscle. Receives: Procedure: Shoulder Posterior Pericapsular Nerve Group (SPENG) Block |
| Posterior Suprascapular and Axillary Nerve Blocks | Active comparator | Participants assigned to this group will receive ultrasound-guided posterior suprascapular and axillary nerve blocks before general anesthesia for shoulder arthroscopy. A total of 20 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be administered, consisting of 10 mL for the posterior suprascapular nerve block and 10 mL for the axillary nerve block. Receives: Procedure: Combined Posterior Suprascapular and Axillary Nerve Blocks |
What is being measured
The primary outcome is the main question the study is designed to answer.
Highest Resting Numeric Rating Scale Pain Score During the First 24 Postoperative Hours
Resting postoperative pain intensity will be assessed using an 11-point Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). For each participant, the highest resting NRS score recorded during the first 24 postoperative hours will be used as the primary outcome. Scheduled assessments will be performed on arrival in the post-anesthesia care unit and at 4, 8, 12, and 24 hours after surgery. Resting NRS scores obtained immediately before rescue analgesic administration outside these scheduled assessments will also be included when determining the highest value.
Measured: From arrival in the post-anesthesia care unit through 24 hours after surgery
Secondary outcomes (15)
Block Performance Time
Time required to perform the allocated regional anesthesia technique, measured in seconds from the first contact of the ultrasound transducer with the skin until removal of the block needle after completion of local anesthetic injection.
Measured: Periprocedural
Proportion of Participants With Complete Dual-Target Sensory Block Success
Cold sensation will be assessed over the posterior shoulder (suprascapular nerve territory) and lateral deltoid region (axillary nerve territory) using a 3-point scale: 0 = absent sensation, 1 = reduced sensation, and 2 = normal sensation. Suprascapular sensory component success will be defined as a reduction of at least one grade from baseline in the posterior shoulder region. Axillary sensory component success will be defined as a reduction of at least one grade from baseline in the lateral deltoid region. Complete dual-target sensory block success will require successful sensory blockade in both territories in the same participant.
Measured: 30 minutes after block completion
Cumulative Opioid Consumption During the First 24 Postoperative Hours
All rescue opioid analgesics administered during the first 24 postoperative hours will be recorded and converted to intravenous morphine-equivalent dose for comparison between groups.
Measured: From arrival in the post-anesthesia care unit through 24 hours after surgery
Time to First Rescue Analgesic
Time from completion of the study block to the first administration of rescue analgesic medication for postoperative pain.
Measured: From block completion through 24 hours after surgery
Resting Numeric Rating Scale Pain Scores
Resting pain intensity will be assessed using an 11-point Numeric Rating Scale from 0 (no pain) to 10 (worst imaginable pain).
Measured: On arrival in the post-anesthesia care unit and at 4, 8, 12, and 24 hours after surgery
Numeric Rating Scale Pain Scores With Movement
Pain intensity during standardized shoulder-related movement will be assessed using an 11-point Numeric Rating Scale from 0 (no pain) to 10 (worst imaginable pain), when clinically feasible.
Measured: On arrival in the post-anesthesia care unit and at 4, 8, 12, and 24 hours after surgery
Anterior Shoulder Numeric Rating Scale Pain Score
Pain localized predominantly to the anterior shoulder will be rated separately using an 11-point Numeric Rating Scale ranging from 0 to 10.
Measured: At 8, 12, and 24 hours after surgery
Posterior Shoulder Numeric Rating Scale Pain Score
Pain localized predominantly to the posterior shoulder will be rated separately using an 11-point Numeric Rating Scale ranging from 0 to 10.
Measured: At 8, 12, and 24 hours after surgery
Proportion of Participants With Hemidiaphragmatic Paresis
Diaphragmatic excursion will be assessed using M-mode ultrasonography. Hemidiaphragmatic paresis will be defined as diaphragmatic excursion 30 minutes after block completion falling to less than 25% of the participant's baseline excursion.
Measured: 30 minutes after block completion
Change in Diaphragmatic Excursion From Baseline
Diaphragmatic excursion will be measured using M-mode ultrasonography as the difference in diaphragm position between resting expiration and deep inspiration. Three measurements will be obtained and averaged. Change from baseline will be evaluated after the block.
Measured: Baseline and 30 minutes after block completion
Shoulder Abduction Motor Strength
Shoulder abduction strength will be evaluated using the Medical Research Council (MRC) scale ranging from 0 to 5, with higher scores indicating greater muscle strength.
Measured: Baseline, 30 minutes after block completion, and 24 hours after surgery
Proportion of Participants With Rebound Pain
Rebound pain will be defined as an increase from an NRS pain score of 3 or lower at the preceding assessment to an NRS score of 7 or higher at the subsequent assessment.
Measured: During the first 24 postoperative hours
Quality of Recovery-15 Score
Postoperative quality of recovery will be assessed using the 15-item Quality of Recovery questionnaire (QoR-15). The total score ranges from 0 to 150, with higher scores indicating better quality of recovery.
Measured: 24 hours after surgery
Patient Satisfaction With Perioperative Analgesia
Overall satisfaction with perioperative analgesia will be rated on an 11-point scale from 0 (completely dissatisfied) to 10 (completely satisfied).
Measured: 24 hours after surgery
Number of Participants With Block-Related Complications
Participants will be assessed for block-related adverse events including hematoma, infection, persistent paresthesia, persistent weakness, and other clinically suspected complications.
Measured: From block performance through postoperative day 7
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Aug 2026
- Study start1 Nov 2026 (estimated)
- Primary completion31 May 2027 (estimated)
- Study completion15 Jun 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Postoperative PainStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Participants will be randomly assigned in a 1:1 ratio to receive either a single-injection Shoulder Posterior Pericapsular Nerve Group (SPENG) block or combined posterior suprascapular and axillary nerve blocks before elective shoulder arthroscopy. Both groups will receive the same total volume, concentration, and dose of local anesthetic.
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 60 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Izmir City Hospital
- Sponsor type
- Other government
- Responsible party
- Principal investigator, Murat Kaykaç, Izmir City Hospital
- Investigators
- Murat KAYKAC, MD, Principal investigator, Izmir City HospitalDerya ARSLAN YURTLU, Professor, Study director, Izmir City Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07762417
- Sponsor's protocol ID
- SPENG-RCT-2026-01
- Acronym
- SPENG-RCT
- Status last verified
- Aug 2026
- First submitted
- 9 Aug 2026
- Last updated
- 14 Aug 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: De-identified individual participant data underlying the results reported in the primary publication may be made available to qualified researchers upon reasonable request to the principal investigator. Data will be shared after publication of the main study results, subject to approval of the proposed use and compliance with applicable ethical and institutional data-protection requirements.
Study at a glance
From the registry record, last updated by the sponsor on 14 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Analgesic Efficacy of the Shoulder Posterior Pericapsular Nerve Group Block Versus Combined Posterior Suprascapular and Axillary Nerve Blocks for Shoulder Arthroscopy: A Randomized, Blinded, Non-Inferiority Trial
- ClinicalTrials.gov ID
- NCT07762417
- Acronym / sponsor ID
- SPENG-RCT / SPENG-RCT-2026-01
- Conditions
- Postoperative Pain, Shoulder Arthroscopy
- Keywords
- Diaphragm-sparing block, Postoperative analgesia, Regional anesthesia, Axillary nerve block, Suprascapular nerve block, Shoulder arthroscopy, Shoulder Posterior Pericapsular Nerve Group block, SPENG block
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 60 participants (estimated)
- Lead sponsor
- Izmir City HospitalOther government
- Study start
- 1 Nov 2026 (estimated)
- Primary completion
- 31 May 2027 (estimated)
- Study completion
- 15 Jun 2027 (estimated)
- First posted
- 13 Aug 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This prospective, randomized, patient- and assessor-blinded, single-center non-inferiority trial will compare the analgesic efficacy of the Shoulder Posterior Pericapsular Nerve Group (SPENG) block with combined posterior suprascapular and axillary nerve blocks in adults undergoing elective shoulder arthroscopy under general anesthesia. Both groups will receive the same total volume and concentration of local anesthetic. The primary outcome will be the highest resting Numeric Rating Scale pain score recorded during the first 24 postoperative hours. Secondary outcomes will include block performance time, sensory block success in suprascapular and axillary nerve territories, opioid consumption, time to rescue analgesia, motor function, diaphragmatic function, postoperative recovery quality, patient satisfaction, and block-related complications.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
- Model description
- Participants will be randomly assigned in a 1:1 ratio to receive either a single-injection Shoulder Posterior Pericapsular Nerve Group (SPENG) block or combined posterior suprascapular and axillary nerve blocks before elective shoulder arthroscopy. Both groups will receive the same total volume, concentration, and dose of local anesthetic.
| Arm | Type | Receives |
|---|---|---|
| SPENG Block | Experimental | Procedure: Shoulder Posterior Pericapsular Nerve Group (SPENG) BlockParticipants assigned to this group will receive an ultrasound-guided Shoulder Posterior Pericapsular Nerve Group (SPENG) block before general anesthesia for shoulder arthroscopy. A total of 20 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be administered as a single injection between the posterior glenoid rim and the deep surface of the infraspinatus muscle. |
| Posterior Suprascapular and Axillary Nerve Blocks | Active comparator | Procedure: Combined Posterior Suprascapular and Axillary Nerve BlocksParticipants assigned to this group will receive ultrasound-guided posterior suprascapular and axillary nerve blocks before general anesthesia for shoulder arthroscopy. A total of 20 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be administered, consisting of 10 mL for the posterior suprascapular nerve block and 10 mL for the axillary nerve block. |
Who may qualify
- Ages
- 18 to 70 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Age 18 to 70 years
- American Society of Anesthesiologists (ASA) physical status I-III
- Scheduled to undergo elective shoulder arthroscopy under general anesthesia
- Able to understand the Numeric Rating Scale for pain assessment
- Able and willing to provide written informed consent
Key exclusion criteria (12 listed)
- Known allergy or hypersensitivity to local anesthetics used in the study
- Infection at the planned block injection site
- Coagulopathy or ongoing anticoagulant therapy that cannot be appropriately interrupted for peripheral nerve block
- Pre-existing neurological deficit affecting the operative upper extremity
- Moderate or severe pulmonary disease
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Shoulder Posterior Pericapsular Nerve Group (SPENG) BlockAlso: SPENG BlockAn ultrasound-guided single-injection posterior pericapsular block. With the participant in the lateral decubitus position and the operative shoulder uppermost, a high-frequency linear ultrasound transducer will be placed transversely immediately inferior to the posterior acromion. After identification of the humeral head, articular cartilage, infraspinatus muscle, and posterior glenoid rim, a block needle will be advanced in-plane in a medial-to-lateral direction. The needle tip will be positioned between the posterior glenoid rim and the deep surface of the infraspinatus muscle, and 20 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be injected. | Procedure or surgery | SPENG Block |
| Combined Posterior Suprascapular and Axillary Nerve BlocksAlso: Posterior Shoulder Blockwo ultrasound-guided nerve blocks will be performed. For the posterior suprascapular nerve block, the suprascapular nerve will be identified in the suprascapular notch region beneath the supraspinatus muscle, and 10 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be administered. For the axillary nerve block, the posterior humeral circumflex artery will be identified using color Doppler in the quadrilateral space, and 10 mL of 0.25% bupivacaine with epinephrine 1:200,000 will be administered adjacent to the axillary nerve. | Procedure or surgery | Posterior Suprascapular and Axillary Nerve Blocks |
Primary outcome
Highest Resting Numeric Rating Scale Pain Score During the First 24 Postoperative Hours
Time frame: From arrival in the post-anesthesia care unit through 24 hours after surgery
Resting postoperative pain intensity will be assessed using an 11-point Numeric Rating Scale (NRS), ranging from 0 (no pain) to 10 (worst imaginable pain). For each participant, the highest resting NRS score recorded during the first 24 postoperative hours will be used as the primary outcome. Scheduled assessments will be performed on arrival in the post-anesthesia care unit and at 4, 8, 12, and 24 hours after surgery. Resting NRS scores obtained immediately before rescue analgesic administration outside these scheduled assessments will also be included when determining the highest value.
15 secondary outcomes
Block Performance Time
Time frame: Periprocedural
Proportion of Participants With Complete Dual-Target Sensory Block Success
Time frame: 30 minutes after block completion
Cumulative Opioid Consumption During the First 24 Postoperative Hours
Time frame: From arrival in the post-anesthesia care unit through 24 hours after surgery
Time to First Rescue Analgesic
Time frame: From block completion through 24 hours after surgery
Resting Numeric Rating Scale Pain Scores
Time frame: On arrival in the post-anesthesia care unit and at 4, 8, 12, and 24 hours after surgery
Numeric Rating Scale Pain Scores With Movement
Time frame: On arrival in the post-anesthesia care unit and at 4, 8, 12, and 24 hours after surgery
Anterior Shoulder Numeric Rating Scale Pain Score
Time frame: At 8, 12, and 24 hours after surgery
Posterior Shoulder Numeric Rating Scale Pain Score
Time frame: At 8, 12, and 24 hours after surgery
Proportion of Participants With Hemidiaphragmatic Paresis
Time frame: 30 minutes after block completion
Change in Diaphragmatic Excursion From Baseline
Time frame: Baseline and 30 minutes after block completion
Shoulder Abduction Motor Strength
Time frame: Baseline, 30 minutes after block completion, and 24 hours after surgery
Proportion of Participants With Rebound Pain
Time frame: During the first 24 postoperative hours
Quality of Recovery-15 Score
Time frame: 24 hours after surgery
Patient Satisfaction With Perioperative Analgesia
Time frame: 24 hours after surgery
Number of Participants With Block-Related Complications
Time frame: From block performance through postoperative day 7
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 14 Aug 2026.
- Individual participant dataSharing planned: Yes. De-identified individual participant data underlying the results reported in the primary publication may be made available to qualified researchers upon reasonable request to the principal investigator. Data will be shared after publication of the main study results, subject to approval of the proposed use and compliance with applicable ethical and institutional data-protection requirements.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Murat KAYKAC, MD principal investigator
Izmir City Hospital
Derya ARSLAN YURTLU, Professor study director
Izmir City Hospital
Questions about this trial
What is this clinical trial studying?
A study testing Shoulder Posterior Pericapsular Nerve Group (SPENG) Block and Combined Posterior Suprascapular and Axillary Nerve Blocks in people with Postoperative Pain and Shoulder Arthroscopy, run by Izmir City Hospital.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 14 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Murat KAYKAC, MD (+905330258450, drmuratkaykac@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Highest Resting Numeric Rating Scale Pain Score During the First 24 Postoperative Hours (time frame: From arrival in the post-anesthesia care unit through 24 hours after surgery). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Aug 2026.