Lateral Sagittal Versus Costoclavicular Approach for Ultrasound-Guided Infraclavicular Brachial Plexus Block: Comparison of Block Dynamics and Patient Comfort
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Enrollment
- 109
- Locations
- 1
- Primary Endpoint
- Start time of the nervous block
Study Overview
Brief Summary
An ultrasound-guided infraclavicular block performed with the costoclavicular (CC) approach and the lateral sagittal (LS) approach will be compared in patients scheduled for forearm and hand surgery.
Detailed Description
The CC approach is a recently introduced infraclavicular approach that targets three cords (medial, lateral and posterior) located lateral to the axillary artery in the costoclavicular space. Cords in this space are located more superficially than with the classical approach at the lateral infraclavicular fossa and are clustered but maintain a consistent anatomical relationship with each other.
Patients will be divided into two groups:
Group LS: Ultrasound-guided infraclavicular block - lateral sagittal approach (20 ml 0.5% bupivacaine)
Group CC: Ultrasound-guided infraclavicular block - costoclavicular approach (20 ml 0.5% bupivacaine)
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Outcomes Assessor)
Eligibility Criteria
- Ages
- 18 Years to 65 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Age 18 years to 65 years
- •Patients scheduled for elective forearm and hand surgeries
- •Patients with American Society of Anesthesiologists (ASA) 1-3
Exclusion Criteria
- •Patients not consenting/unwilling to participate
- •Age <18 years or >65 years
- •Patients with ASA 4
- •Obesity (BMI >30 kg/m2)
- •Regional anesthesia contraindicated (thrombocytopenia, infection at injection site)
- •Severe renal, cardiac, or hepatic disease
- •History of hypersensitivity or allergy to local anesthetics
- •History of opioid or steroid use for more than 4 weeks
- •History of psychiatric disorders
- •Analgesic treatment in the last 48 hours preoperatively
- •Operations lasting less than 60 minutes and more than 180 minutes
- •Patients who converted to general anesthesia
Arms & Interventions
Group LS
Ultrasound-guided infraclavicular block - lateral sagittal approach (20 ml 0.5% bupivacaine)
Intervention: Lateral Sagittal Approach (Procedure)
Group CC
Ultrasound-guided infraclavicular block - costoclavicular approach (20 ml 0.5% bupivacaine)
Intervention: Costoclavicular Approach (Procedure)
Outcomes
Primary Outcomes
Start time of the nervous block
Time Frame: 45 minutes after the block procedure
Time from the local injection to when a pin-prick test yields no response in at least 1 of 3 cords in the extremity on which the operation is being performed.
Duration of start of motor block
Time Frame: 45 minutes after the block procedure
Time from when a Lovett score of 5 is seen in at least 1 of 3 cords in the patient extremity on which the operation is being performed, following local anesthetic injection. Lovett rating scale: 6 = normal muscle strength, 5 = slightly decreased muscle strength, 4 = significantly decreased muscle strength, 3 = slight loss of movement, 2 = significant loss of movement, 1 = near total loss of movement, and 0 = total paralysis. Motor block cord myotomes will be evaluated as medial cord (thumb adduction = ulnar nerve), lateral cord (elbow flexion = mucocutaneous nerve), and posterior cord (wrist extension = radial nerve).
Performance time of the operator
Time Frame: During the block procedure
Time elapsed from when the needle enters the skin after an optimal view is obtained on ultrasound until the block needle exits the skin after the procedure is completed.
Secondary Outcomes
- Time of sensory block(Postoperative Day 1)
- Time of first analgesic request(Postoperative Day 1)
- Surgeon Satisfaction(Postoperative Day 1)
- Time of motor block(Postoperative Day 1)
- Number of needle redirections(During the block procedure)
- Number of patients who required a rescue block(45 minutes after the block procedure)
- Patient Satisfaction(Postoperative Day 1)
- Number of needle attempts(During the block procedure)
Investigators
BURHAN DOST
Assistant Professor
Ondokuz Mayıs University