Hand or Arm Surgery
Conditions
Keywords
upper limb, hand, arm, surgery, supraclavicular nerve block, brachial plexus nerve block, ultrasound-guided regional anesthesia
Brief summary
The ultrasound guided supraclavicular block is a peripheral nerve block which is considered safe, has a fast onset, is dense and provides complete block of the nerves supplying the hand, forearm and arm. However retrospective studies done at Toronto Western Hospital have highlighted the fact that most commonly the ulnar nerve fibres (responsible for sensations in the ring finger, little finger and the corresponding part of hand), sometimes escape this block and need additional supplementary block at a distal peripheral nerve site. It is a confusing fact since all nerve fibres are compactly arranged in a sheath at the supraclavicular level. The local anaesthetic agent at this level should be equally distributed among all nerve fibres. The purpose of this study is to compare two different approaches (medial and lateral) adopted by our clinicians to perform this block and to test the effectiveness of each approach for successful ulnar nerve fibre blockade.
Interventions
PROCEDURELateral-to-Medial Approach
Approach of the needle to administer the brachial plexus nerve block will be done in a lateral-to-medial direction.
PROCEDUREMedia-to-Lateral Approach
Approach of the needle to administer the brachial plexus nerve block will be done in a medial-to-lateral direction.
Sponsors
University Health Network, Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Adult patients presenting for upper limb surgery, excluding shoulder surgery * Age 18-80 yrs * BMI \< 35 * ASA I - III * Consent for the study
Exclusion criteria
* Pre-existing sensory or motor neurodeficit. * Sensitivity to local anaesthetic agents. * Patients on anticoagulants or antiplatelet medications (Minidose Aspirin is acceptable) with abnormal coagulation profile. * Compromised pulmonary reserve due to COPD, Kypho-scoliosis or Restricted lung disease. * Infection or any obvious pathology at the site of block performance * History of drug abuse. * Psychiatric disease or any condition that precludes an informed consent.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Successful block of the Ulnar nerve (C8,T1) fibres. Sensory block with a score of '1' at 30 minutes (loss of sensation to pin prick) is considered successful. | 1 hour prior to surgery |
Countries
Canada
Outcome results
None listed