Hand Surgery, Wrist Surgery, Elbow Surgery, Fracture Fixation, Dupuytren Contracture, Finger Fracture, Wrist Arthropathy, Distal Radius Fracture
Conditions
Keywords
liposomal bupivacaine, supraclavicular nerve block, ultrasound guided nerve block, hand, wrist, elbow surgery, local anesthetic, dexamethasone perineural injection
Brief summary
Patients undergoing hand, wrist, and elbow surgery may experience pain after surgery. The orthopedic surgeon may provide prescription pain medications after surgery to assist with pain control. However, with concern of the opioid epidemic, many patients would rather minimize the use of narcotic pain prescriptions after having surgery. As an alternative, ultrasound guided regional nerve blocks can assist with postoperative pain control. patients consented to this study will be randomized into three groups: 1) will receive an ultrasound guided nerve block with local anesthesia only, 2) will receive an ultrasound guided nerve block with local anesthesia and a steroid dexamethasone, 3) will receive an ultrasound guided nerve block with liposomal bupivacaine. our study team will make phone calls after surgery to the patient to determine how long the block lasted for, and how many opioid pain pills were taken up to 3 days after surgery.
Detailed description
Our study team predicts that the ultrasound guided nerve block with liposomal bupivacaine can last approximately 48 hours, while the block with local anesthesia and dexamethasone will last approximately 30 hours, and the block with local anesthesia only may last up to 24 hours
Interventions
our study team wishes to determine effect of liposomal bupivacaine in regional nerve blocks for surgery of the upper extremity (finger, hand, wrist, elbow)
DRUGDexamethasone
dexamethasone injected in perineural area can extend the regional nerve block
Sponsors
St. Luke's Hospital, Pennsylvania
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
the patient is blinded to the study arm
Intervention model description
randomization into three groups. Control group is administration of local anesthesia in ultrasound guided supraclavicular nerve blocks. There are two study groups. The intermediate study group is administration of local anesthesia with dexamethasone in the ultrasound guided supraclavicular nerve block. The other study group is administration of liposomal bupivacaine in the ultrasound guided supraclavicular nerve block.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* patients scheduled to undergo finger, hand, wrist, elbow surgery with a hand surgeon at St. Luke's University Hospital in Bethlehem, Pennsylvania * patients greater than 18 years of age, able to provide written consent for surgery and study
Exclusion criteria
* patients that cannot provide written consent for finger, hand, wrist, elbow surgery * patients with known allergies to local anesthetics * patients with severe liver disease * patients with a condition known as methemoglobinemia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Subjective length of duration of block | feedback obtained up until day 3 after surgery | our study team contacts the patients 4 days after surgery to ask how long their regional nerve block lasted |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of opioid pills taken until postoperative day 3 | feedback until day 3 after surgery | our study team contacts the patients to ask how many opioid pain pills were taken from arrival to home up until postoperative day 3 |
Countries
United States
Outcome results
None listed