Pain
Conditions
Keywords
nerve stimulator, ultrasound
Brief summary
The investigators compared the postoperative analgesia of nerve stimulator-guided and ultrasound-guided infraclavicular block for upper extremity surgery.
Detailed description
Ultrasound (US)-guided peripheral nerve block has increased in popularity. It has many advantages such as improved success rate, faster onset time, fewer needle passes, shorter performance time, and reduced procedural pain and vascular puncture. However, there is no information about postoperative analgesia. Therefore, the investigators tested whether ultrasound-guided peripheral nerve block enhanced the postoperative analgesia for upper extremity surgery compared with nerve stimulator (NS) guidance.
Interventions
PROCEDURENS-guided infraclavicular block
Patients received a standard single injection infraclavicular block using the lateral sagittal approach of Klaastad. The infraclavicular brachial plexus is identified using an insulated needle connected to a nerve stimulator. Placement of the needle is considered adequate if motor response of radial nerve in the hand or wrist is still present at 0.2 - 0.5mA. Ropivacaine 0.5% 35ml is used.
PROCEDUREUS-guided infraclavicular block
Infraclavicular block is performed under ultrasound guidance. Linear probe is placed in a parasagittal positon below the clavicle medial to the coracoid process and adjusted to achieve a cross-sectional image of the axillary artery. Using in-plane technique, an 22-gauge insulated needle is advanced caudally and posteriorly to the axillary artery. Subsequently, 35 ml of 0.5% ropivacaine is incrementally injected.
Sponsors
Cheju Halla General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists physical class I - III patients scheduled to undergo upper extremity surgery
Exclusion criteria
* coagulopathy, severe pulmonary disease, neuropathy, contralateral diaphragmatic paresis, allergy to study medications
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of postoperative analgesia | at 24h after surgery | time from completion of local anesthetic injection until the first request for an analgesic |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| number of needle redirections | at 30 min after block placement | either forward or backward movement of needle at least 1 cm or more |
| patient discomfort | at 30 min after block placement | pain score (0-10) during the procedure |
| paresthesia | at 30 min after block placement | presence of paresthesia during the procedure |
| onset time | until 30min after completion of local anesthetic | complete block of sensory nerve (radial, ulnar, median, musculocutaneous, and medial antebrachial cutaneous nerve) |
| block performance time | at 30 min after block placement | the time between the block needle insertion and needle withdrawal |
| postoperative dysesthesia | at 24h after surgery | presence of any paresthesia in the operated extremity |
| supplemental analgesia | at 24h after surgery | Rescue analgesia with 75 mg of IM diclofenac was available on demand. |
| Pain score | at 24h after surgery | — |
| Patient satisfaction | at 24h after surgery | The acceptance of the anesthetic technique was evaluated using a two-point score: 1, satisfactory (if necessary, I would have the same anesthetic technique); and 2, unsatisfactory (different anesthetic technique). |
| motor block of hand | at 24h after surgery | presence of motor block in the operated hand |
Countries
South Korea
Outcome results
None listed