A comparative study of anaesthetic injection into the nerves above and below collar bone for hand surgeries using ultrasound

Phase 2/3

Not yet recruiting

Conditions: Crushing injury of forearm, (2) ICD-10 Condition: S629||Unspecified fracture of wrist andhand,

Registration Number: CTRI/2019/07/020470

Lead Sponsor: Dr Anis Fathima

Brief Summary: Upperlimb surgeries canbe performed under general or regional anaesthesia. Regional anaesthesiaoffers several advantages over general anaesthesia such as aconscious patient , avoidance of polypharmacy and airway Intervention, betterhemodynamics, good post- operative analgesia, early resumption of activities,reduced hospital stay and improved functional outcome. Brachial plexus block atthe level of the clavicle can anaesthetize all four distal upper extremitynerve territories producing an intense blockage. Supraclavicular brachialplexus block is a popular technique for upper limb surgeries because of its quickonset and high success rate.This is because at this level, thebrachial plexus elements are tightly grouped and produces a good neurologicalblock. Corner pocket sparing and thereby a less dense ulnar blockade is aproblem in supraclavicular block. So supraclavicular blockade requires atwo point injection. There is a possibility of hornerâ€™s syndrome,phrenic nerve palsy and pneumothorax which may also be considered as itsdisadvantage. The main advantage of infraclavicular block isthe fewer incidences of complications with reduced the risks of inadvertentlung/pleural puncture and avoidance of injury to the neurovascular structuresin the neck. It is an ideal site for catheter technique for continuous infusionof local anaesthetics. There is lesser incidence of ulnar nerve sparing withsingle point injection. The disadvantage is that plexus is situated deeper atthis level and the angle of approach is more acute. This makes thevisualization of the relevant anatomy and the needle tip, challenging ininexperienced hands and in obese patients. Although both supraclavicularand infraclavicular blocks can be performed for upper limb surgeries,anaesthesiologists often have an inclination to supraclavicular block overinfraclavicular block because of an ease of administration. The advent ofreal time ultrasound helps in direct visualisation of nerves and theirsurrounding anatomy. It also allows for continuous observation of the needle tip and the spread of local anaesthetics, reducedlocal anaesthetic dose required to achieve a good block, avoidance of injury tothe nearby vascular structures making ultrasound guided brachial plexus blockhighly appealing to anaesthesiologists. The rational of this study is toevaluate the efficacy of ultrasound guided infraclavicular approach of brachialplexus block compared to ultrasound guided supraclavicular approach of brachialplexus block in upper limb surgeries.

Detailed Description: Not available

Recruitment & Eligibility

Status: Not Yet Recruiting

Sex: All

Target Recruitment: 64

Inclusion Criteria

1.Patients according to American Society of Anaesthesiologists grade 1 or 2.
2.Age between 18-60 years 3.Surgeries involving upper limb (hand and forearm) lasting more than 1 & 1/2 hours.

Exclusion Criteria

BMI morethan 30 kg/m2 5.
Pregnant women 6.
Bleeding disorders, anticoagulant therapy or deranged coagulation profile 7.
Pre-excisting motor or sensory deficit in the operative limb 8.
Infection in the area of injection 9.Hypersensitivity to local anaesthetic agents.

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Group A- block by infraclavicular approach	24 - 48 hrs
Group B- block by supraclavicular approach	24 - 48 hrs
To compare the onset of sensory and motor blockade of brachial plexus between	24 - 48 hrs

Secondary Outcome Measures

Name	Time	Method
1.To compare the duration of sensory and motor block between two Groups.	2.To compare the occurrence of ulnar nerve sparing between the two groups.

Trial Locations

Locations (1): Pondicherry Institute of Medical Sciences
🇮🇳
Pondicherry, PONDICHERRY, India
Pondicherry Institute of Medical Sciences
🇮🇳Pondicherry, PONDICHERRY, India
Dr Anis Fathima
Principal investigator
9786635828
mailanisfathima@gmail.com