ESP Versus SPSIP Block for Pain Relief After Shoulder Arthroscopy

This study will compare two regional anesthesia techniques for pain relief after arthroscopic shoulder surgery: high thoracic erector spinae plane (ESP) block and serratus posterior superior intercostal plane (SPSIP) block. Both techniques involve injecting a local anesthetic into tissue layers in the upper back under ultrasound guidance. The study will include 80 adults aged 18 to 75 years undergoing elective arthroscopic shoulder surgery at Bursa City Hospital. Participants will be randomly assigned to receive either an ESP block or an SPSIP block before general anesthesia. Participants and the clinician assessing postoperative outcomes will not know which block was assigned. All participants will receive a standardized pain management regimen, including a patient-controlled analgesia (PCA) pump that delivers tramadol when they press a button. Additional pain relief will be provided when needed. The main aim is to compare the total amount of tramadol delivered by the PCA pump during the first 24 hours after surgery. Other assessments will include pain at rest and during movement, quality of recovery at 24 hours, additional pain medication requirements, remifentanil use during surgery, and side effects or complications related to the blocks and opioid medications.

Inclusion Criteria: Scheduled for elective arthroscopic shoulder surgery under general anesthesia. Provision of informed consent. Age between 18 and 75 years. American Society of Anesthesiologists (ASA) physical status I-III. - Exclusion Criteria: \- History of bleeding diathesis or current anticoagulant therapy. Known allergy to local anesthetics or opioid medications. Infection at the planned block injection site. Suspected pregnancy, pregnancy, or breastfeeding. Refusal to participate. Uncontrolled diabetes mellitus. Intellectual disability. Regular opioid use for chronic pain management. Technical inability to successfully perform the assigned block.