Hemidiaphragmatic Paralysis, Upper Extremity Surgery
Conditions
Keywords
Infraclavicular brachial plexus block, hemidiaphragmatic paralysis, costoclavicular brachial plexus block
Brief summary
This randomized clinical study aims to compare the effects of two different ultrasound-guided infraclavicular brachial plexus block techniques-costoclavicular and lateral sagittal approaches-in patients undergoing forearm, wrist, or hand surgery. The primary objective of the study is to evaluate and compare the incidence of hemidiaphragmatic dysfunction associated with these two block techniques. Secondary outcomes include sensory and motor block characteristics, postoperative pain scores, analgesic requirements, and potential block-related complications. Eligible adult patients scheduled for elective forearm or hand surgery are randomly assigned to receive either a costoclavicular or a lateral sagittal infraclavicular nerve block using bupivacaine under ultrasound guidance. Standard general anesthesia and postoperative analgesia protocols are applied. The results of this study are expected to provide evidence on the relative safety and efficacy of these two infraclavicular block approaches, particularly regarding diaphragmatic function, and to help guide anesthesiologists in selecting the most appropriate regional anesthesia technique for upper extremity surgery.
Interventions
Ultrasound-guided infraclavicular brachial plexus block performed using either the costoclavicular or lateral sagittal approach with standardized local anesthetic volume.
Sponsors
Gazi University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Intervention model description
This was a prospective, randomized, parallel group study comparing two ultrasound guided infraclavicular block techniques
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Adults aged 18-80 years * ASA physical status I-III * Scheduled for forearm, wrist, or hand surgery * Planned infraclavicular brachial plexus block
Exclusion criteria
* Refusal of regional anesthesia * Known allergy to local anesthetics * Infection at the block site * Pre-existing neurological deficit in the operative limb * Severe pulmonary disease * Coagulopathy or sepsis * BMI \> 40 kg/m² * Psychiatric disorders
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diaphragmatic excursion | Baseline(pre-block) and 30 minutes after block performance. | Diaphragmatic excursion measured by ultrasound during normal and deep breathing to asses the effect of costoclavicular and lateral sagittal infraclavicular block techniques. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Sensory and motor block onset time | Within the first 30 minutes after block performance. | Time from completion of the infraclavicular block to achievement of complete sensory and motor block in the radial, median, ulnar, and musculocutaneous nerve distributions. Sensory and motor function were assessed every 5 minutes for up to 30 minutes after block performance, and block onset time was defined as the time to complete block. |
| Time to first postoperative analgesic requirement | Within the first 24 hours postoperatively. | Time from the end of the surgery to the first analgesic requirement. |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORIrfan Güngör, MD
Gazi University Faculty of Medicine
Outcome results
None listed