Arm Injuries, Wounds and Injuries
Conditions
Keywords
Arm Injuries, Wounds and Injuries, Lidocaine, Levobupivacaine, Bupivacaine, Anesthetics, Central Nervous System Depressants, Physiological Effects of Drugs
Brief summary
Results from our preliminary study accepted as e-poster presentation on ESRA (Bordeaux, September 2012.) showed significant difference in Comfort Score during Ultrasound Guided Supraclavicular Brachial Plexus block (US-SCB) between young and elderly population. However, it is unknown whether the difference in Comfort score (1) was associated with reduction of local anesthetic (LA) volume in elderly or it is attributed to elderly population by itself. The aim of the study is to compare the Comfort score during US-SCB placement in elderly patients undergoing upper limb surgery performed with two different volumes of local anesthetics (20 ml vs 32 ml).
Detailed description
Involutional changes of brachial plexus in elderly, assessed by measuring the cross-sectional area (CSA) of brachial plexus at the first rib, allowed a 35% reduction of LA volume for an effective US-SCB in comparison with the younger patients (2). Ultrasound-guided regional anesthesia becomes an increasingly popular technique and its performance must be as comfortable as possible. Therefore, Comfort score during block placement is extremely important. Comfort Score is consisted of maximum pain intensity (VAS), the satisfaction of the patient and the number of unpleasant events declared by the patients. It is calculated as the sum of each criterion, which was attributed a value of 0 or 1: VAS(\<or=30/100, 1; \>30/100, 0), number of unpleasant events (0, 1; \>or=1, 0) and satisfaction (satisfied or very satisfied, 1; acceptable or unsatisfied, 0). Comfort score of 3 or 2 is considered as comfortable while score 1 or 0 as uncomfortable block placement.
Interventions
PROCEDUREUpper limb surgery
Elderly patients undergoing upper limb surgery received 20 ml of LA volume (50:50 mixture of levobupivacaine 0.5% and lidocaine 2%) for US-SCB. An independent observer unaware of the LA volume recorded maximal pain intensity resulting from block placements, questioned the patients about possible unpleasant events linked to the performance of US-SCB and assessed patient's satisfaction.
Sponsors
Šarić, Jadranka Pavičić, M.D.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* age over 65 years (Elderly group) * upper limb surgery
Exclusion criteria
* refusal of regional anesthesia * any neurologic or neuromuscular disease * clinical signs of cutaneous infection at the site of needle insertion
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Comfort Score | Up to average 20 min | An independent observer unaware of the administered LA volume assessed Comfort score by evaluating maximal pain intensity resulting from block placement using a 100-mm visual analogue scale (VAS: 0, no pain-100, maximum or worst imaginable) as well as by recording any unpleasant event during block placement and by recording patient satisfaction using a four-point scale (unsatisfied, acceptable, satisfied and very satisfied). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Block Placement Time | Up to average 20 minutes | Block placement time was measured as the time elapsing between needle insertion and to last removal of the needle from the patient's neck. |
Countries
Croatia
Contacts
Primary ContactJadranka Pavičić Šarić
Backup ContactJelena Zenko
Outcome results
None listed