Upper Extremity
Conditions
Keywords
upper extremity surgery
Brief summary
Patients will be randomized to one of two groups: 1. Multiple injection group: Axillary brachial plexus block with multiple injections, with the arm abducted, performed with the aid of ultrasound; 2. Single injection group: Axillary brachial plexus block with a single injection, with the arm placed behind the head and the elbow flexed, performed with the aid of ultrasound
Detailed description
The study will be proposed to all patients undergoing formarm or hand surgery under axillary brachial plexus block. Patients will be randomized to one of two groups The first group - multiple injection group - will receive an ultrasound-guided axillary brachial plexus block with the traditional technique, i.e. multiple injections of local anesthetic in proximity to the 4 nerfs that innervate the arm. The arm will be abducted during the block procedure. The second group - single injection group - will receive an ultrasound-guided axillary brachial plexus block with the arm placed behind the head and the elbow flexed. In this position the different nerfs group around the axillary artery where they will be blocked with a single injection of local anesthetic. All patients will receive the same type and amount of local anesthetic: 30 ml of a mixture of ropivacaine 0.5 % + mepivacaine 1 %. The primary outcome measure is the time needed for the performance of the block. Secondary outcomes are: success rate of the block at 30 minutes after the injection, needling time, time to first analgesic request, postoperative opioid consumption, pain scores at 12 and 24 hours postoperatively, block-related complications, and patient satisfaction. These outcomes are further defined in the section below.
Interventions
DRUGMultiple injection local anesthetic
Multiple injection local anesthetic
DRUGSingle injection local anesthetic
Single injection local anesthetic
Sponsors
University of Lausanne Hospitals
Hôpital du Valais
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients who undergo forearm or hand surgery under axillary brachial plexus block
Exclusion criteria
* History of allergic reaction to local anaesthetics * Peripheral neuropathy * Renal or hepatic insufficiency * Coagulation disorders
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Performance time | 10 minutes | Time in minutes from ultrasound probe placement to end of local anesthetic injection |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to first analgesic request | 24 hours | Time in minutes to first analgesic request postoperatively |
| Block-related complications | 24 hours | Infection, bleeding, neurological problems, pain during the 24 postoperative hours |
| Postoperative opioid consumption on postoperative day 1 | 24 hours | intravenous morphine equivalent consumption during the 24 postoperative hours |
| Needling time | 15 minutes | Time in seconds to complete the block |
| Pain scores on postoperative day 1 | 24 hours | Measured on a visual analogue scale between 0 and 10 (0 = no pain, 10 = worst pain imaginable) |
| Patient satisfaction | 24 hours | Assessed by numerical rating scale on a scale between 0 (= completely dissatisfied) and 10 (= completely satisfied) |
| Pain scores at 12 hours postoperatively | 12 hours | Measured on a visual analogue scale between 0 and 10 (0 = no pain, 10 = worst pain imaginable) |
Countries
Switzerland
Outcome results
None listed