Brachial plexus nerve block for upper extremity surgery Surgery
Conditions
Interventions
Patients undergoing upper extremity surgery (elbow and below) under a double-injection costoclavicular brachial plexus block will be assigned to a predetermined volume of adrenalized 1.5% lidocaine.
Sponsors
McGill University Health Centre
Eligibility
Sex/Gender
All
Age
18 Years to 70 Years
Inclusion criteria
Inclusion criteria: 1. Surgery of the distal upper extremity under brachial plexus block 2. Age between 18 and 70 years 3. American Society of Anesthesiologists classification 1-3 4. Body mass index between 20 and 30 kg/m²
Exclusion criteria
Exclusion criteria: 1. Adults who are unable to give their own consent 2. Pre-existing neuropathy (assessed by history and physical examination) 3. Coagulopathy (assessed by history and physical examination and, if deemed clinically necessary, by blood work up i.e. platelets =100, International Normalized Ratio= 1.4 or partial prothrombin time = 50) 4. Renal failure (assessed by history and physical examination and, if deemed clinically necessary, by blood workup up i.e. creatinine =100) 5. Hepatic failure (assessed by history and physical examination and, if deemed clinically necessary, by blood workup up i.e. transaminases =100) 6. Allergy to local anesthetics 7. Pregnancy 8. Prior surgery in the infraclavicular region 9. Chronic pain syndromes requiring opioid intake at home
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Success rate (binary outcome): dose-response data will be used to estimate the minimum effective volume of LA required to successfully anesthetize the brachial plexus in 90% of patients. Success definition: Using a previously reported 16 point sensorimotor scale for musculocutaneus, radial, median and ulnar nerves. A block will be considered successful if, at 30 minutes (after injection), a composite score of at least 14 points (out of a maximum of 16) is obtained. This score has been proven to provide a reliable estimate of surgical anesthesia. Sensory blockade will be graded with a 3-point scale using a cold test to each nerve sensory regions: 0 = no block, 1 = analgesia (patient can feel touch, not cold), 2 = anesthesia (patient cannot fee touch) (3). The cold test will be applied with light touch to avoid confusion with deep pressure sensation. Motor blockade will also be graded on a 3-point scale by elbow flexion (musculocutaneous), thumb abduction (radial), thumb opposition (median) and thumb adduction (ulnar).: 0 = no block, 1 = paresis, 2 = paralysis (3). | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Operator's level of experience (binary): expert vs trainee (expert defined as an experienced operator of a minimum of 60 costoclavicular blocks) 2. Number of needle passes (count): after needle insertion, any needle adjustment requiring 10 mm retraction will be considered an extra pass 3. Performance time (seconds): time necessary to guide the needle to the desired locations 4. Patient discomfort measured using a Visual Analog Scale (VAS) during the block: 0 = minimum discomfort and 10 = maximum discomfort 5. Demographic data: 5.1. Sex (binary): male/female 5.2. Age (years) 5.3. Weight (kilograms) 5.4. Height (centimeters) 5.5. Type of surgery (count): elbow/forearm/wrist/hand 6. Side effects: 6.1. Vascular puncture (binary): yes/no (ultrasound evidence of vascular puncture or blood reflux trough block needle) 6.2. Hematoma at the site of puncture (binary): yes/no (ultrasonographic or clinical evidence of hematoma) 6.3. Toxic effects of LA (binary): yes/no (presence of clinical signs of systemic toxicity to local anesthetics: tinnitus, perioral paresthesia, confusion, seizures, ECG alterations) 6.4. Hoarseness (binary): yes/no 6.5. Phrenic nerve block (count): normal/paresis/paralysis (by ultrasound-assessed excursion change from baseline before block, excursion decrease >25% = paresis, excursion decrease >75% = paralysis) 6.6. Horner’s syndrome (binary): yes/no ( clinical signs) | — |
Countries
Canada
Contacts
Public ContactJulián Aliste
Outcome results
None listed