Anesthesia, Conduction, Brachial Plexus Blockade, Sympathetic Blockade
Conditions
Keywords
supraclavicular brachial plexus block, perfusion index, skin temperature, infraclavicular brachial plexus block, sympathetic blockade
Brief summary
This prospective comparative study will evaluate the sympathetic effects of ultrasound-guided infraclavicular versus supraclavicular brachial plexus blocks in adults undergoing upper-extremity surgery. Sympathetic tone will be monitored noninvasively with simultaneous bilateral measurements of perfusion index (pulse-oximetry-derived) and skin temperature obtained at baseline and at predefined post-block intervals until return to baseline. The primary outcome is the duration of sympathetic block. Secondary outcomes are between-approach differences in the time course of perfusion index and skin temperature, and the incidence and magnitude of rebound sympathetic activity.
Interventions
PROCEDURESupraclavicular brachial plexus block
A linear US probe (7-13 MHz) will be placed in the supraclavicular area in the coronal oblique plane, in-plane technique will be used, and after antisepsis of the area to be blocked, injection will be performed from lateral to medial direction using a 22G 50 mm stimulator needle (Stimuplex A®: B. Braun Melsungen AG, Japan). Intermittent negative aspiration will be performed during all procedures to detect possible vascular puncture. A total of 30 mL of 2% prilocaine containing 0.5% bupivacaine and 5 mcg/mL adrenaline in a 1:1 ratio will be used as local anesthetic.
A linear US probe (7-13 MHz) will be placed in the infraclavicular area through a lateral sagittal approach, in plane technique will be used and injection will be performed using a 22G 100 mm stimulator needle (Stimuplex A®: B. Braun Melsungen AG, Japan) after antisepsis of the area to be blocked. Intermittent negative aspiration will be performed during all procedures to detect possible vascular puncture. A total of 30 mL of 2% prilocaine containing 0.5% bupivacaine and 5 mcg/mL adrenaline in a 1:1 ratio will be used as local anesthetic.
Sponsors
Bozyaka Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* 18 to 65 year old * ASA I-II * Patients scheduled for upper extremity surgery * Fully oriented and able to cooperate * Patients who signed the informed consent form and gave consent to participate in the study
Exclusion criteria
* ASA III-IV-V * Non-cooperation * Disease that interferes with sensory block assessment * Known allergy to the medicines to be used * Pregnant patients * Coagulopathy or thrombocytopenia * Patients with anatomical abnormalities or active infection at the points of application
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Difference in duration of sympathetic blockade after different US-guided brachial plexus blocks | Twenty-four hours after nerve blockage |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in perfusion index between infraclavicular and supraclavicular approaches | Twenty-four hours after nerve blockage | The perfusion index measured by pulse oximetry will be recorded at baseline and twenty-four hours after brachial plexus block. The outcome measure is defined as the change in perfusion index value between the two time points and compared between block approaches. |
Countries
Turkey (Türkiye)
Outcome results
None listed