Diaphragmatic Dysfunction After Supraclavicular Brachial Plexus Block
- Conditions
- Anesthesia
- Interventions
- Diagnostic Test: ultrasonographic diaphragmatic assessment
- Registration Number
- NCT03596190
- Lead Sponsor
- Nova Scotia Health Authority
- Brief Summary
The investigators plan to determine the onset time and incidence of hemidiaphragmatic paresis (HDP) with a double injection supraclavicular nerve block in patients presenting for upper extremity surgery below the elbow.
The hypothesis is HDP following supraclavicular brachial plexus block occurs with-in 15 minutes of block performance and is not associated with subjective dyspnea.
- Detailed Description
This study will be an observational trial to assess the onset time and incidence of hemidiaphragmatic paresis in patients who undergo the double injection ultrasound-guided supraclavicular block. Diaphragmatic dysfunction will be determined by intercostal diaphragm thickening measured using ultrasound. The available image will be saved.
Patients having below the elbow surgery will be be approached by someone from the research team for consent and possible inclusion in the study. This will be done in the anesthesia preoperative assessment clinic, or in the pre-op area on the day of surgery (if a patient was not seen in clinic).
A baseline ultrasonographic diaphragmatic assessment will be completed. Study participants will then receive supraclavicular brachial plexus block as per standard of care. Ultrasonographic diaphragmatic assessment and dyspnea score (using modified Borg dyspnea scale) will be performed every 5 minutes for 30 minutes, or until the patient is transferred to the operating room, whatever comes first. Patients will also undergo an ultrasonographic diaphragmatic assessment and dyspnea score in the recovery room after their surgery.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 35
- Patients presenting for unilateral upper extremity surgery below the level of the elbow (the forearm or hand) who are having a double injection regional block for anesthesia
- 18 years old and over
- Weight 50kg or greater
- English speaking
- American Society of Anesthesiologists physical status 1-3
- Known Chronic Obstructive Pulmonary Disease
- Pregnancy
- Any significant neurologic dysfunction, or inability to visualize the diaphragm during baseline sonographic assessment
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Assessment arm ultrasonographic diaphragmatic assessment -
- Primary Outcome Measures
Name Time Method Frequency of hemi-diaphragmatic paresis Relative change in ultrasound assessment of diaphragmatic thickening (Baseline vs 30 min after supraclavicular block) Number of participants in which hemi-diaphragmatic paresis is detected using ultrasound measurement of diaphragmatic thickening
Onset time of hemi-diaphragmatic paresis Baseline, 5, 10, 15, 20, 25, and 30 minutes after block The average time at which hemi-diaphragmatic paresis is detected using ultrasound measurement of diaphragmatic thickening
- Secondary Outcome Measures
Name Time Method The correlation of subjective dyspnea Baseline, 5, 10, 15, 20, 25, and 30 minutes after block Using the modified Borg dyspnea scale ranging from 0 (no breathlessness at all to 10 (maximal breathlessness)
Incidence of HDP after surgical procedure under supraclavicular brachial plexus block (in post recovery unit). Post-operatively up to 24 hours Based upon sonographic assessment
Trial Locations
- Locations (1)
NSHA
🇨🇦Halifax, Nova Scotia, Canada