Ultrasound Plus Nerve Stimulator Versus Nerve Stimulator Guided Lumbar Plexus Block
- Conditions
- Knee Arthroscopy Surgery
- Interventions
- Procedure: Ultrasound and nerve stimulator guided lumbar plexus blockProcedure: Nerve stimulator guided lumbar plexus block
- Registration Number
- NCT02020096
- Lead Sponsor
- Huazhong University of Science and Technology
- Brief Summary
Ultrasound imaging, an effective tool to localize peripheral nerves, may facilitate block performance. It allows direct visualization of nerve structures, needle guidance in real-time to the target, and observation of local anesthetic diffusion. Some case series have demonstrated significantly faster onset time for interscalene blocks, supraclavicular blocks and axillary brachial plexus blocks under ultrasound than with conventional techniques. Ultrasound guidance also enhances the quality of popliteal sciatic nerve block at the popliteal fossa compared with single injection, nerve stimulator-guided block using either a tibial or peroneal endpoint. Despite this impressive profile, the application of the ultrasound for lumbar plexus blocks has not been studied extensively. It is likely that lumbar plexus block (LPB) combined with either a sciatic nerve block or sedation or both is equivalent to general anesthesia and neuraxial anesthesia for knee arthroscopy. The lumbar plexus block is traditionally performed using surface anatomical landmarks and nerve stimulation. Ultrasound imaging of the anatomy relevant for LPB is challenging because of its deep anatomic location and the "acoustic shadow" of the overlying transverse processes. Recently, Karmakar M.K. etc. has demonstrated that a paramedian transverse scan (PMTS) of the lumbar paravertebral region with the ultrasound beam being insonated through the intertransverse space (ITS) and directed medially toward the intervertebral foramen (PMTS-ITS) may overcome the problem of the "acoustic shadow" and allow clear visualization of the anatomy relevant for LPB. However, the application of a PMTS-ITS used for lumbar plexus blocks has not been studied extensively and its advantages are not validated in a clinical study. Thus, we designed this prospective, randomized, subject and assessor blinded, parallel-group, active-controlled study to compare a PMTS ultrasound-guided lumbar plexus block combined with nerve stimulation and a conventional technique on time required to readiness for surgery in patients undergo knee arthroscopy surgery.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 48
- Informed consent
- Age 18-70yr
- American Society of Anesthesiologists physical status I-II
- Patients scheduled to undergo knee arthroscopy surgery
- Ultrasound visibility score equal or great than 10
- Body mass index more than 35 kg/m²
- Pregnant or lactating women
- Allergy to local anesthetics
- Coagulopathy, on anticoagulants
- Malignancy or infection at puncture site
- Significant peripheral neuropathy or diabetic peripheral neuropathy
- Language barrier
- Neuropsychiatric disorder
- Severe cardiac or respiratory diseases
- Pathology or previous surgery or trauma to the lower limb
- Analgesics intake, history of substance abuse
- History of spinal surgery or deformity
- Ultrasound visibility score less than 10
- Participating in the investigation of another experimental agent
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description U+N group Ultrasound and nerve stimulator guided lumbar plexus block Ultrasound and nerve stimulator guided lumbar plexus block combined with nerve stimulator guided sciatic block N group Nerve stimulator guided lumbar plexus block Nerve stimulator guided lumbar plexus block combined with nerve stimulator guided sciatic nerve block
- Primary Outcome Measures
Name Time Method Onset time of sensory block to cold and pinprick up to 40 min after ropivacaine injection Onset time of sensory block (cold/pinprick), defined as time interval from completion of local anesthetic injection to the achievement of complete sensory block (defined as no sensation in three major branches including the femoral nerve, the lateral femoral cutaneous nerve and the obturator nerve) .
- Secondary Outcome Measures
Name Time Method Incidence of paresthesia during block up to 20min after needle insertion Incidence of paresthesia during block reported by patients
Performance time of block up to 20 min after needle insertion Performance time of block is the preparing time and procedure time. Preparing time (defined as the time from the beginning of the sterile preparation right before the first needle contact with the skin). Procedure time (time between the insertion of the needle and the end of local anesthetic injection)
Number of needle passes during block up to 20min after needle insertion Number of needle passes during block
Total ultrasound visibility score (UVS) 30 min before and 5 min after lumbar plexus block The independent observer attempted to visualize 10 paravertebral structures in images of the ultrasound scans from the patients
Onset time of motor block up to 40min after ropivacaine injection onset time of motor block, defined as time interval from completion of local anesthetic injection to the achievement of satisfied motor block (defined as a Modified Bromage scale equal to 3).
Incidence of accidental vascular puncture up to 20min after needle insertion Incidence of accidental vascular puncture, defined as blood by aspiration.
Changes of muscle strength of quadriceps femoris and adductors up to 40min after ropivacaine injection Muscle strength of quadriceps femoris and adductors was measured with hand-held dynamometer (HHD, Hogan Health Industries, MicroFET3) during knee extension and hip adduction.
Minimal stimulating current of the needle up to 20min after needle insertion All peripheral nerve blocks were performed by the same anesthesiologist with an 100-mm insulated stimulating needle attached to a nerve stimulator. The intensity of the stimulating current, initially set to deliver 1 to 1.5 mA (0.1ms, 2Hz), was gradually decreased to \<0.5 mA while the appropriate motor response was maintained.
For sciatic block, the targeted evoked motor response was plantar flexion of the foot. For lumbar plexus block, quadriceps muscle motor response was targeted.Contraction should stop below a current of 0.2mA, otherwise intraneural needle position should be suspected and the needle should be withdraw and readjusted. The Minimal stimulating current ( intensity of the current when the needle was considered to be adequately positioned) finally demonstrated on nerve stimulator was recorded, then ropivacaine was injected slowly after careful intermittent aspirations.
Trial Locations
- Locations (1)
Tongji Hospital
🇨🇳Wuhan, Hubei, China