The Need for Supplemental Blocks in Infraclavicular Brachial Plexus Blocks

Completed

• Conditions: Anesthesia, Regional
• Interventions: Procedure: Medial approach infraclavicular block with single injection; Procedure: Medial approach infraclavicular block with triple injection

• Registration Number: NCT04102358
• Lead Sponsor: Derince Training and Research Hospital

Brief Summary

Theoretically, all surgeries below mid-humerus can be done under infraclavicular (IC) blocks. Following the introduction of ultrasonography (USG) to clinical anesthesia, plexus, and nerve blocks under the guidance of USG have gained wide acceptance for the high rates of block success and low risk of complications (1). In this study, the main aim is to evaluate the single injection and triple injection techniques in IC blocks with a USG-guided medial approach in terms of block success and the need for supplementary blocks. The secondary goals are to compare the complication rates and sensory block durations and to discuss the possible reasons for the failure of the blocks.

Detailed Description

Theoretically all surgeries below mid-humerus can be done under infraclavicular (IC) blocks. Following the introduction of ultrasonography (USG) to the clinical anesthesia, plexus and nerve blocks under the guidance of USG have gained wide acceptance for the high rates of block success, and low risk of complications. At the same time, it was also shown that USG-guided IC blocks can shorten procedural times and accelerate the onset of the blocks.

Several methods for IC blocks have been described. Based on the anatomical knowledge, we hypothesized that in medial approaches the need for supplementary blocks would be low with single injections as well as triple injections. In this study, the main aim is to evaluate the single injection and triple injection techniques in IC blocks with a USG-guided medial approach in terms of block success and the need for supplementary blocks. The secondary goals are to compare the complication rates and sensory block durations and to discuss the possible reasons for the failure of the blocks.

Medical records of 139 patients scheduled for elective or emergent hand, wrist, forearm, elbow, and distal arm surgery were analyzed. Patients older than 14 years with ASA physical status I-III who underwent surgery between October 2017 and March 2019 were retrospectively evaluated. Exclusion criteria included non-cooperative patients, refusal of the regional anesthesia, known neuropathy that could prevent the evaluation of the efficacy of the block, different techniques used for infraclavicular brachial plexus blocks (lateral sagittal, coracoid, ...etc.), and known allergy to local anesthetic drugs.

Study Timeline

• Study Start: 2017-10-01
• Primary Completion: 2019-03-31
• Study Completion: 2019-05-30
• Study First Submitted: 2019-09-23
• Study First Submitted QC: 2019-09-23
• Study First Posted: 2019-09-25
• Status Verified: 2024-02
• Last Update Submitted: 2024-02-16
• Last Update Posted: 2024-02-20

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 139

Inclusion Criteria

• ASA physical status I-III
• upper extremity surgery
• blocks were performed by the same anesthesiologist

Exclusion Criteria

• non-cooperative patients
• refusal of the regional anesthesia
• known neuropathy
• different technique used for infraclavicular brachial plexus blocks (lateral sagittal, coracoid, ...etc.)
• known allergy to local anesthetic drugs.

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Single injection	Medial approach infraclavicular block with single injection	Patients who received an infraclavicular block with a single injection technique were included in Group-S.
Triple injection	Medial approach infraclavicular block with triple injection	Patients who received an infraclavicular block with a triple injection technique were included in Group-T.

Primary Outcome Measures

Name	Time	Method
Supplemented blocks	1 hour	30 minutes after the block, if one or two of the median, radial, ulnar or musculocutaneous nerves were still unblocked, these nerves were located either with a peripheric nerve stimulator or an ultrasound, in the axilla or on the more distal parts of their traces on arm and forearm and then supplemented.

Secondary Outcome Measures

Name	Time	Method
Discomfort during IC block	1 hour	paresthesia during the infraclavicular block
Complete Failure	30 minutes	If more than two of these nerves (median, radial, ulnar or musculocutaneous) were remained unblocked, no supplementary blocks were applied, then it was considered as having a failed block and general anesthesia was administered.
Recovery of sensory block	24 hours	the first time of the need for analgesics
Inadvertent vascular puncture	1 hour	inadvertent vascular puncture during the infraclavicular block

Trial Locations

Locations (1)

Derince Training and Research Hospital; 🇹🇷 Kocaeli, Derince, Turkey