Single injection vs double injection technique in USG guided supraclavicular brachial plexus block

Completed

Conditions: Unspecified fracture of wrist andhand,

Registration Number: CTRI/2018/01/011076

Lead Sponsor: Tata Main Hospital

Brief Summary: Ultrasound guided supraclavicular brachial plexus block provides fast onset, complete, safe and reliable anesthesia for upper limb surgery. However there were limited literatures describing the optimal injection technique in the brachial plexus under ultrasound guidance. Few literatures suggest that the single injection of local anesthetics in the corner pocket formed by the intersection between subclavian artery and the 1st rib is enough to get adequate surgical anaesthesia. Others suggested multiple injections to achieve adequate spread of drug in the plexus. However the overall success of surgical anesthesia didnâ€™t differ significantly at the end of 30 minutes.

In most places double injection technique of ultrasound guided supraclavicular block (half of total volume of local anesthetic injected in the corner pocket and other half inside the plexus or upper part of brachial plexus) is followed and taught. However double injection technique requires multiple needle passes, which increases patient discomfort.

Though single corner pocket injection is associated with less no of needle passes and less procedural time, but associated with delayed onset and sometimes less successful block of the musculocutaneus nerve.

Therefore we felt the need to find out a technique that will combine the benefits of both the above techniques to ensure quick and effective block with minimal needle passes. So we modified the double injection technique where two injections are given in a single needle pass. In this technique we injected only 1/3rd of drug (10 ml of Ropivacaine 0.5%) at the corner pocket and rest 2/3rd of drug (20 ml of 0.5% Ropivacaine) in the center of neural cluster while withdrawing the needle. No needle redirection is done during the 2nd injection as needle is just withdrawn in to the neural cluster after injecting in the corner pocket.

To find out the effectiveness of this novel technique, we set up a study to compare it with single corner pocket injection technique (30 ml of 0.5% Ropivacaine deposited in the corner pocket formed by 1st rib and subclavian artery) in terms of onset and quality of block.

We hypothesise that the two injection technique will lead to quicker and complete block of upper limb than the single injection technique.

Detailed Description: Not available

Recruitment & Eligibility

Status: Completed

Sex: All

Target Recruitment: 80

Inclusion Criteria

ASA 1 to 3 patients who are planned for forearm surgery.

Exclusion Criteria

Uncooperative patients 2.
Patients with neurological disorder or preexistin neurological deficits in the operative limb 3.
Patients allergic to Ropivacaine 4.
Infection at the site of injection 5.
BMI>35 6.Severe coagulopathy.

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
To assess and compare onset of block (time to complete sensory and motor block in the distribution of ulnar, median, radial and musculocutaneus nerves) in both arms	Sensory and motor blocks will be evaluated post injection every 5 min until 30 min by an anesthesiologist blinded to the technique of injection.

Secondary Outcome Measures

Name	Time	Method
Duration of sensory block:	Duration of motor block:

Trial Locations

Locations (1): Tata Main Hospital
🇮🇳
Singhbhum, JHARKHAND, India
Tata Main Hospital
🇮🇳Singhbhum, JHARKHAND, India
Dr Bhanu Pratap Swain
Principal investigator
06576641166
bhanu_swain@yahoo.co.in