Anesthesia, Local, Brachial Plexus Block, Nerve Block
Conditions
Keywords
Protective Nerve Stimulation, Regional Anesthesia, Sciatic nerve block, femoral nerve block, brachial plexus block
Brief summary
Peripheral nerve blocks can be conducted with ultrasound, electrical nerve stimulation or landmark technique or a combination of this techniques. Whether a regional block should be conducted with a combination of those different possibilities is highly discussed. In this study the investigators want to show the effectiveness of new standard way of combined use of ultrasound and nerve stimulation, they call protective nerve stimulation. According to ethical vote we are conducting an observational study.
Detailed description
All patients will get the regional block they need for the elective surgery. Before starting the block a standard monitoring will be established. After applying the monitoring the block will be performed by an experienced anesthetist in supervision of another experienced anesthetist. The nerve stimulator is set on a fixed current of 1.0 mA and a block without motoric response on this current is tried. Ultrasound images are saved. After performing the regional anesthesia the further anesthetic procedure will be carried out and the surgery will take place. After surgery the patients will be transported to the recovery room or Postanesthesia care unit.
Interventions
None listed
Sponsors
Charite University, Berlin, Germany
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* written informed consent * age of 18 or older * elective surgery patients at Campus Charité Mitte with clinical benefit of regional anesthesia
Exclusion criteria
* existing contraindication for regional nerve blocks or the use of Protective Nerve Stimulation * patients who undergo outpatient treatment * allergy against local anesthetics * age under 18 years * Lacking willingness to take part in the study * ASA PS score of 4 or more * preexisting neural damage in the effect area * Diabetes mellitus, alcohol use disorder * Participation in other prospective clinical interventional trials * Accommodation in an institution due to an official or judicial order
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Effectivity | Duration of preparation, surgery and recovery room (an average of 4 hours) | Effective motor blockade and sensitive blockade at fixed timepoints |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain while blocking | Duration of preparation, surgery and recovery room (an average of 4 hours) | Does the patient have pain while blocking? Pain during hospital stay will be measured with the Numeric Rating Scale (NRS-V). For patients unable of pain self-assessment (e.g. ventilated patients, patients in delirious state or patients with stroke affecting language skills) observer-rated pain scales will be applied: Behavioural Pain Scale (BPS for ventilated) and BPS-NI (for non-ventilated) patients. |
| Pain after surgery | Duration of preparation, surgery and recovery room (an average of 4 hours) | Does the patient have pain after surgery? Pain during hospital stay will be measured with the Numeric Rating Scale (NRS-V). For patients unable of pain self-assessment (e.g. ventilated patients, patients in delirious state or patients with stroke affecting language skills) observer-rated pain scales will be applied: Behavioural Pain Scale (BPS for ventilated) and BPS-NI (for non-ventilated) patients. |
| Satisfaction | Duration of preparation, surgery and recovery room (an average of 4 hours) | Satisfaction of the patient in a 6-step Likert scale |
| Impedance | Duration of preparation, surgery and recovery room (an average of 4 hours) | impedance measured by the nerve stimulator while proceeding with the needle |
| Changes of impedance | Duration of preparation, surgery and recovery room (an average of 4 hours) | changes of impedance measured by the nerve stimulator while proceeding with the needle |
| Muscle contractions | Duration of preparation, surgery and recovery room (an average of 4 hours) | Number of expected and unexpected muscle contractions |
| Paresthesia | Duration of preparation, surgery and recovery room (an average of 4 hours) | Number of expected and unexpected paresthesia |
Other
| Measure | Time frame | Description |
|---|---|---|
| pruritus | Duration of preparation, surgery and recovery room (an average of 4 hours) | Appearance of pruritus before, during and after the block (yes/no) |
| Analgetics consumption | Duration of preparation, surgery and recovery room (an average of 4 hours) | Amount of opioids needed before, during and after the surgery until the patient leaves the recovery unit |
| Bloody Tap | Duration of preparation, surgery and recovery room (an average of 4 hours) | Appearance of Bloody Tap before, during and after the block (yes/no) |
| Postoperative Nausea and Vomiting | Duration of preparation, surgery and recovery room (an average of 4 hours) | Appearance of PONV before, during and after the block (yes/no) |
Countries
Germany
Outcome results
None listed