Comparison of Supraclavicular and Costoclavicular Brachial Plexus Blocks in Pediatrics
- Conditions
- Anesthesia, LocalPostoperative Pain
- Interventions
- Registration Number
- NCT04782778
- Lead Sponsor
- Istanbul University
- Brief Summary
In upper extremity surgeries, the brachial plexus block can be performed with different techniques at various levels depending on the proximal and distal level of the surgery.
As an alternative to the infraclavicular brachial plexus block, which has been used for many years and which we routinely perform to every pediatric patient under general anesthesia; Costoclavicular block is recommended due to its advantages such as short application time, single injection and sufficient ultrasound imaging, and its use is becoming widespread. There are studies comparing these two methods. However in this study, we aim to compare the postoperative analgesic effects of US-guided costoclavicular technique with US-guided supraclavicular technique, which is more common for many years and is performed 2-3 cm proximal to the costoclavicular block area.
During the block application, the US imaging time, the difficulty level of needle imaging, the number of maneuvers required to reach the target image, whether additional maneuvers are required according to the local anesthetic distribution, the success of the block and the duration of the surgery, the total application time of the block and the duration of general anesthesia will be recorded. Mean arterial pressure and heart rate will be recorded at 30-minute intervals during the surgery. Standardized for pediatric patients The FLACC and Wong-Baker pain scores will be followed first 24 hours after surgery. The patient will be examined for pain, motor and sensation, and analgesic doses will be recorded if used. Time to first pain identification, duration of sleep, patient and surgeon satisfaction will be recorded.
The rarely onset of hemidiaphragmatic paralysis during supraclavicular block reduces its use. Costoclavicular block could be a safe and effective alternative. One of our seconder objectives is to assess the incidence of hemidiaphragmatic paralysis following ultrasound-guided supraclavicular block and compare it to that of costoclavicular block. For this purpose diaphragmatic excursion is visualized by M-mode ultrasonography 30 minutes after extubation. In B-mode, the diaphragm thickness measurement at the end of expiratory and inspiratory end is recorded and the diaphragm thickness fraction is calculated. Absence of diaphragmatic excursion during a sniff test or sighing defined the hemidiaphragmatic paralysis.
- Detailed Description
Peripheral nerve blocks; It is widely used in daily practice for anesthesia or as a part of multimodal analgesia in most surgical procedures. In upper extremity surgeries, the brachial plexus block can be performed with different techniques at various levels depending on the proximal and distal level of the surgery. In this study, the aim is to compare postoperative analgesic effects of these two ultrasound-guided techniques in pediatric patients.
As an alternative to the infraclavicular brachial plexus block, which has been used for many years and which we routinely perform to every pediatric patient under general anesthesia; Costoclavicular block is recommended due to its advantages such as short application time, single injection and sufficient ultrasound imaging, and its use is becoming widespread. There are studies comparing these two methods. However, we aim to compare the costoclavicular technique with the supraclavicular technique, which is more common for many years and is performed 2-3 cm proximal to the costoclavicular block area. Thus demonstrate the safety of upper extremity blocks, which is an important part of multimodal analgesia, and to determine the most ideal technique in the pediatric patient group who will undergo upper extremity surgery.
During the block application, the US imaging time, the difficulty level of needle imaging, the number of maneuvers required to reach the target image, whether additional maneuvers are required according to the local anesthetic distribution, the success of the block and the duration of the surgery, the total application time of the block and the duration of general anesthesia will be recorded. Mean arterial pressure and heart rate will be recorded at 30-minute intervals during the surgery. Standardized for pediatric patients The FLACC and Wong-Baker pain scores will be followed first 24 hours after surgery. The patient will be examined for pain, motor and sensation, and analgesic doses will be recorded if used. Time to first pain identification, duration of sleep, patient and surgeon satisfaction will be recorded.
The rarely onset of hemidiaphragmatic paralysis during supraclavicular block reduces its use. Costoclavicular block could be a safe and effective alternative. One of our seconder objectives is to assess the incidence of hemidiaphragmatic paralysis following ultrasound-guided supraclavicular block and compare it to that of costoclavicular block. For this purpose diaphragmatic excursion is visualized by M-mode ultrasonography 30 minutes after extubation. In B-mode, the diaphragm thickness measurement at the end of expiratory and inspiratory end is recorded and the diaphragm thickness fraction is calculated. Absence of diaphragmatic excursion during a sniff test or sighing defined the hemidiaphragmatic paralysis.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 58
- Undergoing unilateral upper extremity surgery (distal midhumerus).
- ASA(American Society of Anesthesiology) 1-3
- Receiving family consent from the parents that they accept regional analgesia
- Parents refusal
- Infection on the local anesthetic application area
- Infection in the central nervous system
- Coagulopathy
- Brain tumors
- Known allergy against local anesthetics
- Anatomical difficulties
- Syndromic patient
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Costoclavicular Block Bupivacaine 0.25% Injectable Solution US-guided lateral approach costoclavicular block with 1 mg/kg Bupivacaine (%0,25) Ultrasound Guided Supraclavicular Block Bupivacaine 0.25% Injectable Solution US-guided supraclavicular block with 1 mg/kg Bupivacaine (%0,25)
- Primary Outcome Measures
Name Time Method Total block application time Up to 15 minutes Total block application time from the needle's entrance to the exit from the skin
- Secondary Outcome Measures
Name Time Method Motor blockade physical examination Up to 24 hours Each nerve scored on 0-2 point scale so that total score ranges from 0 to 8. Total scores of 0 point is defined as absent motor blockade (full movement); 1 point as partial blockade (able to free movement only) or 2 point as complete blockade (unable to move). (Separately for these four nerves; N. Medianus, N. ulnaris, N. radialis and N. musculocutaneous).
Patient number who require additional analgesic Up to 24 hours Number of patients who require IV morphine (0.03 mg/kg) and paracetamol
Ideal USG guided brachial plexus cords visualization/needle pathway planning time Up to 15 minutes Practitioner's ideal image acquisition time
Needle tip and shaft imaging visualization Up to 15 minutes Likert scale: 1-5 (1:very hard 5:very easy)
Number of needle maneuvers Up to 15 minutes Number of needle maneuvers according to local anesthetic distribution
Total procedure difficulty according to the anesthesiologist Up to 15 minutes Likert Scale: 1-5 (1:very hard 5:very easy)
Patient number requiring rescue analgesics Intraoperative 2-4 hours If a ≥ 20% increase above preinduction values in MAP or HR was observed during the perioperative period, additional fentanyl dose (1 μg/kg) was applied intravenously.
Wong Baker FACES scale Up to 24 hours The scale shows a series of faces ranging from a happy face at 0, or "no hurt", to a crying face at 10, which represents "hurts like the worst pain imaginable"
Sensorial blockade physical examination Up to 24 hours Each nerve scored on 0-2 point scale with pinprick test so that total score ranges from 0 to 8. Total scores of 0 point is defined as absent sensorial blockade (feels pain), 1 point as partial blockade (feels touch) or 2 point as complete blockade (no sense). (Separately for these four nerves; N. Medianus, N. ulnaris, N. radialis and N. musculocutaneous).
Complications/side effects Up to first week Vascular puncture, hematoma, pleura puncture, infections, phrenic nerve paralysis
Incidence of symptomatic/asymptomatic postprocedural phrenic nerve paralysis Up to 2 hours Diaphragmatic excursion is visualized by M-mode ultrasonography 30 minutes after extubation. In B-mode, the diaphragm thickness measurement at the end of expiratory and end of inspiratory is recorded and the diaphragm thickness fraction is calculated.
Time to postoperative first pain Up to 24 hours Time to first analgesic
Family satisfaction Up to 24 hours Satisfaction score: 0: very unsatisfied, 3: very satisfied
Surgeon satisfaction Up to 24 hours Satisfaction score: 0: very unsatisfied, 3: very satisfied
Face, Legs Activity, Cry, Consolability (FLACC) scores Up to 24 hours It corporates five categories of behavior, each scored on 0-2 point scale so that total score ranges from 0 to 10. Total scores of 0-3 is defined as mild or no pain, 4-7 as moderate, and 8-10 as severe pain.
Duration of sleep Up to 24 hours Total hours of sleep first day
Trial Locations
- Locations (1)
Istanbul University
🇹🇷Istanbul, Fatih, Turkey