Lateral Sagittal Versus Costoclavicular Approach for Ultrasound-Guided Infraclavicular Brachial Plexus Block: Comparison of Block Dynamics and Patient Comfort
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 109
- 试验地点
- 1
- 主要终点
- Start time of the nervous block
研究概览
简要总结
An ultrasound-guided infraclavicular block performed with the costoclavicular (CC) approach and the lateral sagittal (LS) approach will be compared in patients scheduled for forearm and hand surgery.
详细描述
The CC approach is a recently introduced infraclavicular approach that targets three cords (medial, lateral and posterior) located lateral to the axillary artery in the costoclavicular space. Cords in this space are located more superficially than with the classical approach at the lateral infraclavicular fossa and are clustered but maintain a consistent anatomical relationship with each other.
Patients will be divided into two groups:
Group LS: Ultrasound-guided infraclavicular block - lateral sagittal approach (20 ml 0.5% bupivacaine)
Group CC: Ultrasound-guided infraclavicular block - costoclavicular approach (20 ml 0.5% bupivacaine)
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Age 18 years to 65 years
- •Patients scheduled for elective forearm and hand surgeries
- •Patients with American Society of Anesthesiologists (ASA) 1-3
排除标准
- •Patients not consenting/unwilling to participate
- •Age <18 years or >65 years
- •Patients with ASA 4
- •Obesity (BMI >30 kg/m2)
- •Regional anesthesia contraindicated (thrombocytopenia, infection at injection site)
- •Severe renal, cardiac, or hepatic disease
- •History of hypersensitivity or allergy to local anesthetics
- •History of opioid or steroid use for more than 4 weeks
- •History of psychiatric disorders
- •Analgesic treatment in the last 48 hours preoperatively
- •Operations lasting less than 60 minutes and more than 180 minutes
- •Patients who converted to general anesthesia
研究组 & 干预措施
Group LS
Ultrasound-guided infraclavicular block - lateral sagittal approach (20 ml 0.5% bupivacaine)
干预措施: Lateral Sagittal Approach (Procedure)
Group CC
Ultrasound-guided infraclavicular block - costoclavicular approach (20 ml 0.5% bupivacaine)
干预措施: Costoclavicular Approach (Procedure)
结局指标
主要结局
Start time of the nervous block
时间窗: 45 minutes after the block procedure
Time from the local injection to when a pin-prick test yields no response in at least 1 of 3 cords in the extremity on which the operation is being performed.
Duration of start of motor block
时间窗: 45 minutes after the block procedure
Time from when a Lovett score of 5 is seen in at least 1 of 3 cords in the patient extremity on which the operation is being performed, following local anesthetic injection. Lovett rating scale: 6 = normal muscle strength, 5 = slightly decreased muscle strength, 4 = significantly decreased muscle strength, 3 = slight loss of movement, 2 = significant loss of movement, 1 = near total loss of movement, and 0 = total paralysis. Motor block cord myotomes will be evaluated as medial cord (thumb adduction = ulnar nerve), lateral cord (elbow flexion = mucocutaneous nerve), and posterior cord (wrist extension = radial nerve).
Performance time of the operator
时间窗: During the block procedure
Time elapsed from when the needle enters the skin after an optimal view is obtained on ultrasound until the block needle exits the skin after the procedure is completed.
次要结局
- Time of sensory block(Postoperative Day 1)
- Time of first analgesic request(Postoperative Day 1)
- Surgeon Satisfaction(Postoperative Day 1)
- Time of motor block(Postoperative Day 1)
- Number of needle redirections(During the block procedure)
- Number of patients who required a rescue block(45 minutes after the block procedure)
- Patient Satisfaction(Postoperative Day 1)
- Number of needle attempts(During the block procedure)
研究者
BURHAN DOST
Assistant Professor
Ondokuz Mayıs University