A comparative study of ultrasound guided costoclavicular versus supraclavicular brachial plexus block in patients undergoing upperlimb surgery.
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 84
- 试验地点
- 1
- 主要终点
- The primary outcome is the onset of complete sensory and motor blockade at after LA injection.
研究概览
简要总结
One of the most popular methods of administering anaesthesia and pain releif for upper limb surgery is a regional brachial plexus block. Brachial plexus can be blocked by supraclavicular, infraclavicular, costoclavicular, axillary and interscalene approaches.
The use of ultrasound in these blocks enhances the success rates and reduces complications significantly. It improves the visualisation of nerve bundles, enables real time assessment of needle placement and this has lead to reduction in the total volume of anaesthetic drugs required. It also helps in avoiding crucial structures such as pleura, blood vessels and enhances the precision of the local anaesthesic drug infiltration along the targeted nerves.
Supraclavicular brachial plexus block(SCBPB) is often called the spinal anaesthesia of the arm, due to its rapid onset of blockade. For the supraclavicular (SC) approach, the trunk and divisions of the brachial plexus are arranged compactly superolaterally around the subclavian artery at the supraclavicular fossa. However, complications such as hemidiaphragmatic paralysis due to phrenic nerve blockade, Horner’s syndrome due to sympathetic nerve block and pneumothorax may occur.
Costoclavicular approach of BPB is a modification of ultrasound guided infraclavicular approach of BPB. Under ultrasound guidance, the costoclavicular space (CCS) is visualised as a well defined intermuscular space , lying deep and posterior to midpoint of clavicle. It is located between the clavicular head of pectoralis major and subclavius muscle anteriorly and the upper slips of serrtus anterior muscle and second rib posteriorly. All 3 cords of brachial plexus are more superficial and visualized in a single transverse sonogram of CCS as the cords are clustered together lateral to axillary artery. Therefore a a low dose of LA(local anaesthetic) and single injection would provide more effective blockade. Block needle can be easily directed to the centre of the plexus with minimal discomfort to patient.
The danger of vascular puncture and pleural puncture is minimized with costoclavicular approach as the nerve cords are first approached before vessel and the pleura.
研究设计
- 研究类型
- Observational
入排标准
- 年龄范围
- 18.00 Year(s) 至 65.00 Year(s)（—）
- 性别
- All
入选标准
- •Patients aged between 18 to 65 years posted for elective upperlimb surgeries.
- •American Society of Anaesthesiologists (ASA) physical status 1and 2.
排除标准
- •Pre-existing pulmonary pathologies.
- •Pre-existing known neuropathy concerning the forearm present surgery.
- •Infection on the needle insertion site.
- •Coagulopathies.
- •Pregnancy.
- •Body mass index more than 30kg/m
- •Allergy to local anaesthetics.
结局指标
主要结局
The primary outcome is the onset of complete sensory and motor blockade at after LA injection.
时间窗: . The sensory blockade of the four nerves will be evaluated and graded every 3 mins until 30 mins after injection by double blinded observers using a 3 point scale (0 = no block , 1 = analgesia i.e patient can feel touch but not cold, 2 = anaesthesia i.e patient cannot feel touch). Motor blockade will be tested and graded according to a 3 point scale ( 0 = no block, 1 = paresis, 2 = paralysis). Motor blockade of each nerve will be evaluated by elbow flexion for (MCN), wrist flexion for (MN), wrist extension for (RN), flexion and opposition of fifth finger towards the thumb for (UN).
次要结局
- To compare the performance time, number of needle passess and duration of analgesia between the two techniques.(To assess the incidence of complications such as hemidiaphragmatic dysfunction, pneumothorax, Horners syndrome and vessel puncture.)
研究者
Dr Geetha CR
MS Ramaiah Medical College and Hospital