Ultrasound-Guided Brachial Plexus Regional Anesthesia by the Novel Retroclavicular Approach : A Feasibility Study
Overview
- Phase
- Phase 4
- Intervention
- Not specified
- Conditions
- Describe Novel Approach to Brachial Plexus Anesthesia
- Sponsor
- Université de Sherbrooke
- Enrollment
- 50
- Locations
- 1
- Primary Endpoint
- Success Rate of the Block
- Status
- Completed
- Last Updated
- 12 years ago
Overview
Brief Summary
The goal of this study is to demonstrate that the novel retroclavicular approach is a safe, fast and effective technique for ultrasound-guided brachial plexus anesthesia.
Detailed Description
Classic infraclavicular approach of the brachial plexus involves a needle puncture below the clavicle and advancing the needle with a 45-60 degree angle from cephalad to caudad. The aim is to advanced the block needle posterior to the axillary artery and to deposit the local anesthetic at that point, near the posterior cord. A "U" shaped spread around the artery should ensure distribution around all three cords. Ultrasound guidance is highly recommended and neurostimulation is optional. The retroclavicular approach is a variant to this classical technique. Ultrasound probe is positioned initially below the clavicle in a manner similar to the classic approach but is then rotated in a clockwise fashion (right arm) or counter-clockwise fashion (left arm) for about 25-35 degrees. The puncture site is just behind the clavicle at the most lateral point available. If initial entry point is optimal, needle direction is then parallel to ultrasound probe. The final aim and position of block needle is identical to classical approach. Entry point ensures a parallel alignment of the needle and the ultrasound beam, thus enabling almost perfect visualization of both artery, cords and block needle. This is turn optimizes safety, rapidity of technique, efficiency and efficacy.
Investigators
Pablo Echave
Anesthesiologist
Université de Sherbrooke
Eligibility Criteria
Inclusion Criteria
- •Elective or Urgent Surgery of the hand, wrist or forearm
- •18 years and older
- •Ability to consent
- •American Society of Anesthesiologists class 1 to 3
Exclusion Criteria
- •Infection at the site of infection
- •Abnormal anatomy at the site of infection
- •Coagulopathy
- •Severe Pulmonary Disease
- •Preexisting neurological symptom(s) in the operated arm
- •Pregnant patients
- •Patients weighing less than 50 kg
- •Allergy to amide type local anesthetics
Outcomes
Primary Outcomes
Success Rate of the Block
Time Frame: Assessed 30 minutes after block completion
Success is defined as complete sensory loss in the distribution of the radial, median, ulnar, musculocutaneous, and medial cutaneous nerves of the forearm and hand.
Secondary Outcomes
- Surgical success rate(Defined at the beginning of surgery until the end of surgery)
- Technique duration(Time required in seconds for the retroclavicular block technique completion, assessed during block performance)
- Needle visualization(Assessed after study completion, once all 50 patients will have been completed. Assessment will take place in the weeks following study completion)
- Patient discomfort(Assessed immediately after the block)
- Patient satisfaction(Assessed 48 hours after the block)
- Sensitive Block Progression(Assessed 10, 20, 30 minutes after the block)
- Motor Block Progression(Assessed 10, 20, 30 minutes after the block)
- Complication Rate(Assessed 48 hours after the block)
- Duration of the Block's Effects(Assessed 48 hours after the block)
- Use of narcotic for tourniquet pain(Assessed throughout the surgery)
- Rate of Neurostimulation Usage(Assessed during the block)