A Randomized Comparison Between Single- and Double-injection Ultrasound-Guided Costoclavicular Block
Overview
- Phase
- Not Applicable
- Intervention
- Single injection
- Conditions
- Upper Extremity Injury
- Sponsor
- McGill University Health Centre/Research Institute of the McGill University Health Centre
- Enrollment
- 90
- Locations
- 1
- Primary Endpoint
- Onset time of brachial plexus blockade
- Last Updated
- 7 years ago
Overview
Brief Summary
In this trial, the objective is to compare single- and double-injection ultrasound-guided costoclavicular blocks. The rationale behind this idea is that a second local anesthetic injection, inside the costoclavicular space, may compensate for the dynamic cord dispersion seen with the single-injection technique. Thus the research hypothesis is that, compared to its single-injection counterpart, a double injection costoclavicular block will result in a shorter onset time.
Detailed Description
The costoclavicular block (CCB) constitutes a relatively novel technique for infraclavicular brachial plexus blockade, whereby local anesthetics (LAs) are injected inside the costoclavicular space. In this location, the 3 cords of the brachial plexus are very tightly clustered together; this topography would theoretically result in a very swift brachial plexus block Unfortunately, in two recent trials comparing CCB and conventional infraclavicular brachial plexus block, the authors were unable to detect differences in success rate, onset times and LA requirement between the 2 methods. It could be speculated that the explanation resides in dynamic cord dispersion. With CCB, the initial needle target lies in the middle of the 3 cords of the brachial plexus. However, with LA injection, the cords can quickly migrate away from each other. Thus, the anatomical benefits conveyed by the initial compact topography may be lost. In this trial, the objective is to compare single- and double-injection ultrasound-guided costoclavicular blocks. The rationale behind this idea is that a second local anesthetic injection, inside the costoclavicular space, may compensate for the dynamic cord dispersion seen with the single-injection technique. Thus the research hypothesis is that, compared to its single-injection counterpart, a double injection costoclavicular block will result in a shorter onset time.
Investigators
De Tran
Professor
McGill University Health Centre/Research Institute of the McGill University Health Centre
Eligibility Criteria
Inclusion Criteria
- •age between 18 and 75 years
- •American Society of Anesthesiologists classification 1-3
- •body mass index between 18 and 30
Exclusion Criteria
- •adults who are unable to give their own consent
- •pre-existing neuropathy (assessed by history and physical examination)
- •coagulopathy (assessed by history and physical examination and, if deemed clinically necessary, by blood work up i.e. platelets ≤ 100, International Normalized Ratio ≥ 1.4 or partial thromboplastin time ≥ 50)
- •renal failure (assessed by history and physical examination and, if deemed clinically necessary, by blood work up i.e. creatinine ≥ 100)
- •hepatic failure (assessed by history and physical examination and, if deemed clinically necessary, by blood work up i.e. transaminases ≥ 100)
- •allergy to local anesthetic
- •pregnancy
- •prior surgery in the infraclavicular costoclavicular region
- •chronic pain syndromes requiring opioid intake at home
Arms & Interventions
Single Injection
Local anesthetic injection with a mixture of 35 mL of lidocaine 1.0%-bupivacaine 0.25% with epinephrine 5 µ/mL and dexamethasone 2 mg, in the middle of the three cords of the brachial plexus
Intervention: Single injection
Single Injection
Local anesthetic injection with a mixture of 35 mL of lidocaine 1.0%-bupivacaine 0.25% with epinephrine 5 µ/mL and dexamethasone 2 mg, in the middle of the three cords of the brachial plexus
Intervention: lidocaine, bupivacaine, epinephrine, dexamethasone
Double Injection
Local anesthetic injection with a mixture of 35 mL of lidocaine 1.0%-bupivacaine 0.25% with epinephrine 5 µ/mL and dexamethasone 2 mg, in the middle of the three cords of the brachial plexus as well as at the intersection of the subclavian artery and the medial cord.
Intervention: Double injection
Double Injection
Local anesthetic injection with a mixture of 35 mL of lidocaine 1.0%-bupivacaine 0.25% with epinephrine 5 µ/mL and dexamethasone 2 mg, in the middle of the three cords of the brachial plexus as well as at the intersection of the subclavian artery and the medial cord.
Intervention: lidocaine, bupivacaine, epinephrine, dexamethasone
Outcomes
Primary Outcomes
Onset time of brachial plexus blockade
Time Frame: Within 30 minutes of block performance
Onset until a minimal composite score of 14 points in a scale of 0-16 points, evaluating sensitive and motor function of each 4 terminal branches.
Secondary Outcomes
- Performance time during the brachial plexus block(Intraoperative (During block performance))
- Procedure pain during the brachial plexus block(Intraoperative (During block performance))
- Incidence of surgical anesthesia(Thirty minutes after block performance)
- Number of needle passes(Intraoperative (During block performance))
- Incidence of Adverse events(Intraoperative (During block performance))