Disorder of Upper Extremity
Conditions
Keywords
retroclavicular approach, coracoid approach, ultrasound, upper limb surgery, needle visibility, infraclavicular brachial plexus block
Brief summary
The primary aim of this study is to compare needle tip visibility between the coracoid approach and retroclavicular approach for infraclavicular brachial plexus block in patients undergoing elective upper limb surgery. Secondary aim is to investigate the differences between the two groups in the needle shaft visibility, sensorial block success rate, block performance time, block performance related pain, motor block success rate, surgical success rate, complications, patient satisfaction, use of supplemental local anesthetic, use of analgesic.
Detailed description
Infraclavicular blocks are performed with different approaches. Infraclavicular block is usually traditionally performed at coracoid approach. Different approaches has been described for this block such as vertical approach. This study evaluated the effectiveness, safety and feasibility of a retroclavicular brachial plexus block as compared with traditionally coracoid approach for infraclavicular brachial plexus block. 100 patients scheduled for elective upper limb surgery were recruited and randomized into two groups: Coracoid approach for infraclavicular block (Group I), retroclavicular approach for infraclavicular block (Group R). Sensory block, adverse effects and complications were evaluated and recorded every 10 minutes until 30min after local anesthetic injection.Success rate of each nerve sensory block, complications, rate of satisfaction, rate of failure and incidence rate of adverse effects, the needle tip and shaft visibility, procedure time,duration of the block's effect, use of supplemental local anesthetic, use of analgesic.are compared with both groups.
Interventions
OTHERcoracoid approach
Coracoid approach for ultrasound guided infraclavicular brachial plexus block
retroclavicular approach for ultrasound guided infraclavicular brachial plexus block
Sponsors
Antalya Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* patients who undergo elective forearm or hand surgery under infraclavicular brachial plexus block * American Society of Anesthesiologists class 1 to 3 * Ability to consent
Exclusion criteria
* History of allergic reaction to local anaesthetics * Peripheral neuropathy * Renal or hepatic insufficiency * Coagulation disorders
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Needle visibility | 10 minutes after the needle inserted the skin | To assess the needle visibility will be reviewed by two anesthesiologists using a 5-point Likert scale. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient satisfaction using a visual analogue scale | Assessed 48 hours after the block | Using a visual analogue scale , patients will quantify their satisfaction with the retroclavicular coracoid technique. |
| Surgical success rate | 6 hours after the block | Surgical success is defined as no requirement for additional local anesthetic and the use of intravenous analgesic, rescue blocks, or general anesthesia during the surgery. |
| supplemental analgesic use | 90 minutes after block completion | the need for additional intravenous analgesic |
| Technique duration | Time required in seconds for the block completion (10 minutes) | Number of seconds needed to complete the block, from time the first insertion of the blocking needle to its removal. |
| motor block success rate | Assessed 40 minutes after block completion | Motor function is evaluate for flexion of the elbow, opposition of the thumb, and adduction of the thumb based on a three point scale (0 = normal strength, 1 = paresis, 2 = paralysis) |
| Success Rate of the sensorial Block | Assessed 30 minutes after block completion | Sensory assessments are performed every 5 minutes after needle removal for 30 minute in the regions of the radial, median, ulnar, musculocutaneous of the forearm based on a three point scale with cold test ( 0: normal sensation, 1:analgesia, 2: anesthesia). |
| Block performance related pain | 10 minutes after the needle inserted the skin | Block performance related pain is evaluated with a verbal rating scale score after the removel of the needle. |
| complications such as pneumothorax, hemothorax, intraarterial injection, intravenous injection | 24 hours | Patients are asked about possible complications and all the patients studied is evaluated by performing bedside ultrasound examinations of the chest before discharge. |
Countries
Turkey (Türkiye)
Outcome results
None listed