Nerve Block
Conditions
Brief summary
The real-time visualization of a needle and nerve during an ultrasound-guided nerve block can be challenging. These difficulties may partly explain the systemic complications of local anesthetics under ultrasound. Injection of small amounts of a solution around the anesthetized nerve (hydro-dissection) has been proposed to enhance contrast outlining its borders and also to improve the visualization of the needle tip. The glucose solution 5% solution is interesting because it allows, unlike saline, to maintain the motor response with neurostimulation. The hydro-dissection can be particularly useful when one suspect hypoechoic vessels near the nerve to be anesthetized. Thereby, the nerve well demarcated and separated from the vessels, injection of local anesthetic is performed in the circumferential diffusion space (like a small pocket) without redirecting needle. The influence of this hydro-dissection on the nerve block efficiency is unknown. The nerve block quality can be improved because the entire anesthetic is injected in contact with the nerve, but it can also be reduced due to the dilution of the local anesthetic by the glucose solution. In this randomized study, the investigators test the hypothesis that hydro-dissection does not alter the nerve block onset time.
Interventions
PROCEDUREmedian nerve block
median nerve block performed using ultrasound guidance
PROCEDUREmedian nerve block after hydro-dissection
median nerve block performed after hydro-dissection (glucose 5% solution), both using ultrasound guidance
Sponsors
Hopital Foch
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients with an ASA physical status I-II scheduled for elective ambulatory surgery of the hand or wrist involving the median nerve
Exclusion criteria
* Patients with type 1 or 2 diabetes mellitus, * History of clinical or laboratory evidence of abnormal bleeding, * Infection at the injection site, * Allergy to local anesthetic, * Preexisting central or peripheral muscular or neurological disease (for example: carpal tunnel syndrome)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Onset time of sensory blockade (light touch test: total loss of sensation at the two distal phalanges of index) | 30 minutes after injection |
Secondary
| Measure | Time frame |
|---|---|
| Onset time (light touch test at thenar eminence) | 30 minutes after injection |
| Onset time for motor blockade | 30 minutes after injection |
| Success rate (% of patients with total light touch block at index finger within 30 min evaluation period) | 30 minutes after injection |
| Onset time of sensory blockade (cold test at index finger and thenar eminence) | 30 minutes after injection |
| Duration of nerve blockade | 12 hours |
| Nerve block complication | one month |
| Duration of the puncture procedure | 30 minutes after the beginning of the procedure |
| Successful surgical anesthesia | 30 minutes after injection |
Countries
France
Outcome results
None listed