Phrenic Nerve Paralysis
Conditions
Keywords
Retroclavicular, Supraclavicular, Diagphram, hemiparesis, nerve block, regional anesthesia, anesthesiology
Brief summary
The aim of this study is to evaluate differences between ultrasound guided supraclavicular versus retroclavicular brachial plexus blocks: two similar brachial plexus nerve block techniques that differ in their needle trajectory and injection site.
Detailed description
To date, there has not been a study that has compared clinically the retroclavicular brachial plexus block to the supraclavicular brachial plexus block or other brachial plexus blocks. The aim of this study is to evaluate differences between ultrasound guided supraclavicular versus retroclavicular brachial plexus blocks, with primary focus on the incidence of diminished ipsilateral hemidiaphramatic excursion (ipsilateral phrenic nerve blockade). We will also evaluate differences between the two techniques in the success of producing surgical anesthesia, procedural time to perform the block (including imaging time and needling time), block onset time, ease of quality ultrasound needle visualization, and incidence of paresthesias, vascular puncture and pneumothorax. Lastly, we will observe and compare the distribution of motor and sensory blockade of the two techniques
Interventions
PROCEDURESupraclavicular vs Retroclavicular Nerve Block
An ultrasound-guided supraclavicular or retroclavicular nerve block with 30 ml of 0.5% ropivicaine will be performed on patients scheduled for lower arm surgery; 25 ml to be delivered to the brachial plexus and 5 ml to the intercostal nerve
Sponsors
Brigham and Women's Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. patients scheduled for lower arm surgery 2. patients aged 18 years or older 3. patients ASA class I-III
Exclusion criteria
1. Patients unable to cooperate or consent to the study 2. pre-existing neuropathy 3. significant pulmonary disease 4. contralateral phrenic nerve or diaphragmatic dysfunction 5. allergy to local anesthetics 6. infection at needle insertion site 7. history of coagulopathy 8. BMI \> 40 kg/m2
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of IIpsilateral Diaphragmatic Paresis | 30 minutes post block, then postoperatively | As evidence by ipsilater diagphragmatic excursion measured by Mmode ultrasound |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Anesthetic and analgesic efficacy | 30 minutes post block, then postoperatively | Block success will be defined as onset of acceptable sensory and motor blockade |
| Procedural times (imaging time and needling time), onset time, ease of placement, and block duration | at the time of block | Ultrasonographic block imaging times (time between ultrasound probe placement on the patient and satisfactory image of target anatomy acquisition. needling time (time between needle insertion into the skin and the end of local anesthetic injection through the block needle), onset and duration of sensory block, and proceduralist's rating of ease of block performance will be measured. |
| Complication rates | 1 day | Rates of vascular puncture, pneumothorax and paresthesias will be recorded |
| Nerve block distribution | 30 minutes post block | measured through sensation (cold and pin prick) over dermatomes of the brachial plexus |
Countries
United States
Outcome results
None listed