A Prospective, Randomized Comparison Between Single and Double Injection Ultrasound-Guided Axillary Brachial Plexus Block
Overview
- Phase
- Not Applicable
- Intervention
- Ultrasound guided axillary plexus block with 1 injection
- Conditions
- Anesthesia
- Sponsor
- Institut Kassab d'Orthopédie
- Enrollment
- 320
- Primary Endpoint
- Success rate
- Last Updated
- 11 years ago
Overview
Brief Summary
The investigators conducted this prospective, randomized, observer-blinded, non-inferiority trial to compare single perivascular injection to double injection (musculocutaneous nerve and perivascular injection) US guided axillary brachial plexus block.
Detailed Description
The investigators have been challenged by the question of whether all a single injection may be enough to successfully perform a axillary plexus block. Three hundred and twenty patients undergoing elective hand surgery under axillary brachial plexus block will be enrolled into this prospective, randomized, observer-blinded non inferiority trial. Using a computer-generated sequence of random numbers and sealed envelope technique, the patients included will randomly be allocated to receive either single or double injection ultrasound-guided axillary block. The block will be performed with the in-plane technique using a 22 gauge, 50 mm needle and a high frequency linear probe. In the 2 injection group, the needle will initially be advanced toward musculocutaneous nerve and 7 ml of LA (lidocaine 1.5% with epinephrine 5µg/ml) will be deposited around the nerve. The needle will be then advanced until the tip will be positioned just dorsal to the artery and 28 ml of (lidocaine 1.5% with epinephrine 5µg/ml) will be deposited in this location. In the single injection group using the same LA, and 35 ml will be deposited dorsal the artery.
Investigators
Eligibility Criteria
Inclusion Criteria
- •18-75 year of age, ASA physical status I-III, BMI 25 to 35 Kg/m2
Exclusion Criteria
- •non consents patients, any contraindication to brachial plexus anesthesia (local anesthetic allergy, local infection and coagulopathy), preexisting neuropathy, hepatic or renal failure, pregnancy and surgery in the axillary region.
Arms & Interventions
single injection
Axillary plexus block performed with single injection dorsally to the artery
Intervention: Ultrasound guided axillary plexus block with 1 injection
single injection
Axillary plexus block performed with single injection dorsally to the artery
Intervention: lidocaine 1.5% with epinephrine 5µg/ml
Double injection
Axillary plexus block performed with 2 injections: one over musculocutaneous nerve the second one dorsally to the artery
Intervention: Ultrasound guided axillary plexus block with 2 injections
Double injection
Axillary plexus block performed with 2 injections: one over musculocutaneous nerve the second one dorsally to the artery
Intervention: lidocaine 1.5% with epinephrine 5µg/ml
Outcomes
Primary Outcomes
Success rate
Time Frame: 2 hours after the block performance
the percentage of patients who successfully complete surgery without any additional anesthesia. Will be assessed at the end of the surgery with an expected average time of 2 hours.
total anesthesia-related time
Time Frame: <30 minutes after the block performance
The total anesthesia-related time is the sum of performance and onset time (see below).
Secondary Outcomes
- number of needle passes(5 minutes)
- imaging time(5 minutes)
- Onset time(every 5 minutes until 30 minutes after the end of the block performance)
- needling time(5 minutes)
- Sensory blockade(every 5 minutes until 30 minutes after the end of the block performance)
- Performance time(10 minutes)
- Motor blockade(every 5 minutes until 30 minutes after the end of the block performance)
- Composite score(every 5 minutes until 30 minutes after the end of the block performance)