Description of the Brachial Plexus Block at the Humeral Head in Children: a Sono-anatomical Study

Not yet recruiting

• Conditions: Anesthesia, Local; Brachial Plexus; Pressure
• Interventions: Other: Sono-anatomical Study

• Registration Number: NCT06158243
• Lead Sponsor: Centre Hospitalier Universitaire Saint Pierre

Brief Summary

the investigators are interested in assessing the feasibility and value of brachial plexus block at the level of the humeral head in children. As a first step, the investigators propose to carry out a sono-anatomical study to describe the plexus at this level, the distribution of nerves in relation to the axillary artery, and the description of bone and muscle structures.

Detailed Description

Brachial plexus blocks below the clavicle provide anesthesia and analgesia of the upper limb for elbow, forearm and hand surgery. Among the techniques described, axillary and costo-clavicular blocks are most frequently used.

In the axillary approach to the brachial plexus, the ulnar, median and radial nerves are in the direct vicinity of the axillary artery. However, there is considerable variability in the location of these nerves . What's more, the musculocutaneous nerve is most often distant from the other nerves of the plexus. These disadvantages are not encountered with the costo-clavicular technique, in which the nerves are brought together in the same diffusion space. On the other hand, this method does run the risk of pneumothorax and anesthesia of the phrenic nerve.

In this context, the investigators have described the brachial plexus block at the level of the humeral head in adults, which enables practicians to work on nerves gathered around the axillary artery without any risk of phrenic or pulmonary damage4.

In children, Small et al described a supra-clavicular approach, but Clayton et al, noting the high risk of pneumothorax, strongly advocated the axillary approach.

Study Timeline

• Status Verified: 2023-11
• Study First Submitted: 2023-11-20
• Study First Submitted QC: 2023-11-27
• Last Update Submitted: 2023-11-27
• Study Start: 2023-12
• Study First Posted: 2023-12-06
• Last Update Posted: 2023-12-06
• Primary Completion: 2024-04
• Study Completion: 2024-04

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 50

Inclusion Criteria

• patient ASA 1-2
• aged 0 to 10 years
• scheduled surgery
• parental consent obtained

Exclusion Criteria

• Parental refusal to participate
• suspicion of local skin infection
• inability to place the limb in the position required for sonographic examination
• Upper limb malformation
• ASA III, IV
• Major surgery (cardiac, neurosurgery...)
• emergencies

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
6-8	Sono-anatomical Study	children aged 6 to 8 years
0-2	Sono-anatomical Study	children aged 0 to 2 years

Primary Outcome Measures

Name	Time	Method
description of the position of the nerves around the axillary artery	through study completion, around 5 months	Hourly distribution of nerve structures around the axillary artery , expressed in degrees and measured with a protractor

Secondary Outcome Measures

Name	Time	Method
distance between anatomical structures	through study completion, around 5 months	depth of diffusion spaces Skin-cartilage distance Cartilage thickness Skin-nerve distance Skin-to-vessel distance size of nerves all these measurements in centimeters