Anesthesia, Local, Brachial Plexus Block, Nerve Block
Conditions
Keywords
Anesthesia, Conduction, Ultrasound, Brachial Plexus Block/methods, Infraclavicular, Costoclavicular approach, Lateral Sagittal approach, Upper Extremity
Brief summary
An ultrasound-guided infraclavicular block performed with the costoclavicular (CC) approach and the lateral sagittal (LS) approach will be compared in patients scheduled for forearm and hand surgery.
Detailed description
The CC approach is a recently introduced infraclavicular approach that targets three cords (medial, lateral and posterior) located lateral to the axillary artery in the costoclavicular space. Cords in this space are located more superficially than with the classical approach at the lateral infraclavicular fossa and are clustered but maintain a consistent anatomical relationship with each other. Patients will be divided into two groups: Group LS: Ultrasound-guided infraclavicular block - lateral sagittal approach (20 ml 0.5% bupivacaine) Group CC: Ultrasound-guided infraclavicular block - costoclavicular approach (20 ml 0.5% bupivacaine)
Interventions
PROCEDURELateral Sagittal Approach
The US probe will be located medial to the coracoid process in the sagittal plane in the infraclavicular region, and then three cords of the brachial plexus will be viewed. Using the in-plane technique, bupivacaine 0.5% will be administered around the posterior cord (7ml), lateral cord (7ml), and medial cord (6ml).
PROCEDURECostoclavicular Approach
The US probe will be placed parallel to the clavicle in the midclavicular area and tilted toward the cephalad and the axillary artery, and three cords will be viewed. A needle will be forwarded from lateral to medial with the in-plane technique, and 20 ml of bupivacaine 0.5% will be administered at the center of the three cords.
Sponsors
Ondokuz Mayıs University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* Age 18 years to 65 years * Patients scheduled for elective forearm and hand surgeries * Patients with American Society of Anesthesiologists (ASA) 1-3
Exclusion criteria
* Patients not consenting/unwilling to participate * Age \<18 years or \>65 years * Patients with ASA 4 * Obesity (BMI \>30 kg/m2) * Regional anesthesia contraindicated (thrombocytopenia, infection at injection site) * Severe renal, cardiac, or hepatic disease * History of hypersensitivity or allergy to local anesthetics * History of opioid or steroid use for more than 4 weeks * History of psychiatric disorders * Analgesic treatment in the last 48 hours preoperatively * Operations lasting less than 60 minutes and more than 180 minutes * Patients who converted to general anesthesia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Performance time of the operator | During the block procedure | Time elapsed from when the needle enters the skin after an optimal view is obtained on ultrasound until the block needle exits the skin after the procedure is completed. |
| Duration of start of motor block | 45 minutes after the block procedure | Time from when a Lovett score of 5 is seen in at least 1 of 3 cords in the patient extremity on which the operation is being performed, following local anesthetic injection. Lovett rating scale: 6 = normal muscle strength, 5 = slightly decreased muscle strength, 4 = significantly decreased muscle strength, 3 = slight loss of movement, 2 = significant loss of movement, 1 = near total loss of movement, and 0 = total paralysis. Motor block cord myotomes will be evaluated as medial cord (thumb adduction = ulnar nerve), lateral cord (elbow flexion = mucocutaneous nerve), and posterior cord (wrist extension = radial nerve). |
| Start time of the nervous block | 45 minutes after the block procedure | Time from the local injection to when a pin-prick test yields no response in at least 1 of 3 cords in the extremity on which the operation is being performed. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Surgeon Satisfaction | Postoperative Day 1 | Surgeon satisfaction will be evaluated at the end of the operation day using the VRS. VRS: 0-100, 0 = no discomfort at all, 100 = excessive discomfort. |
| Number of needle redirections | During the block procedure | Number of needle redirections until target area is reached: number of attempts to withdraw and redirect the needle without total withdrawal from the skin. |
| Time of sensory block | Postoperative Day 1 | Time when the patient describes pain or when the pin-prick test yields a positive response in the extremity on which the operation is performed. |
| Number of patients who required a rescue block | 45 minutes after the block procedure | Patients subjected to an additional rescue block due to positivity in a pin-prick test at a sensorial examination 45 minutes after the block procedure; these patients will be recorded. |
| Time of first analgesic request | Postoperative Day 1 | Time at which the first analgesic is requested. |
| Number of needle attempts | During the block procedure | Number of needle attempts required until target area is reached: number of withdrawals and redirections of the needle with total withdrawal from the skin. |
| Time of motor block | Postoperative Day 1 | Time when Lovett score is 2 at any of the 3 dermatomes of the extremity on which the operation is being performed. Lovett rating scale 6 = normal muscle strength, 5 = slightly decreased muscle strength, 4 = significantly decreased muscle strength, 3 = slight loss of movement, 2 = significant loss of movement, 1 = near total loss of movement, and 0= total paralysis. Motor block cord myotomes will be evaluated as medial cord (thumb adduction=ulnar nerve), lateral cord (elbow flexion= mucocutaneous nerve), and posterior cord (wrist extension=radial nerve). |
| Patient Satisfaction | Postoperative Day 1 | The discomfort produced by the procedure will be evaluated using the visual rating scale (VRS) at the end of the operation day. VRS: 0-100, 0 = no discomfort at all, 100 = excessive discomfort. |
Countries
Turkey (Türkiye)
Outcome results
None listed