Optimization of Catheter Insertion Site for Continuous Peripheral Nerve Blocks

University of California, San Diego60 enrolled

Overview

This research study is to determine if the insertion site of a perineural catheter or tiny tube placed next to the nerves that go to the part of the body (hand or arm) having surgery, affects the amount of pain relief that is experienced after surgery. Catheters will be placed in either the supraclavicular or infraclavicular location.

To determine if a particular perineural local anesthetic catheter location (supraclavicular or infraclavicular) will maximize postoperative analgesia, minimize oral opioid requirements, minimize sleep disturbances resulting from postoperative pain, and maximize patient satisfaction.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Upper-extremity Surgery Post-operative Pain

Interventions

Supraclavicular vs. Infraclavicular ropivicaine infusionPROCEDURE

Patients will be randomized to one of two groups: nerve blocks in the supraclavicular location or the infraclavicular location. Following surgery the patient will be called by study staff to assess pain scores, sleep disturbances, infusion side effects, feeling in fingers and other study outcomes.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18 years of age or older * unilateral, upper (at or distal to the elbow) extremity orthopedic surgery with moderate-to-severe postoperative pain expected * patients already agree to and want a continuous brachial plexus block for postoperative analgesia Exclusion Criteria: * patients who have difficulty understanding the study protocol or caring for the infusion pump/catheter system * patients who have any known contraindication to study medications * insulin-dependent diabetes mellitus * neuropathy of any etiology in the affected extremity * contraindication to regional blockade (e.g. clotting deficiency) * any known acute or chronic hepatic or renal insufficiency or failure * any incision site outside of the catheter-effected area * chronic opioid use * history of opioid abuse * obesity * pregnancy * incarceration * inability to communicate with the investigators and hospital staff

Locations (1)

UCSD Medical Center

San Diego, California, United States

Outcomes

Primary Outcomes

Surgical pain as measured on a 0-10 scale where 0=no pain and 10=worst imaginable pain. The values for the two different catheter locations will be compared to see which site is optimal for catheter placement.

Time frame: 3 days

Secondary Outcomes

Opioids consumed by patient each day after surgery as reported to study staff.

Time frame: 3 days

Sleeping disturbances (difficulty sleeping and awakenings due to pain) as reported to the study staff.

Time frame: 3 days

Infusion side effects (shortness of breath) as reported to study staff.

Time frame: 3 day

Satisfaction with pain control as measured on a 0-10 scale where 0=very unsatisfied and 10=very satisfied, as reported to study staff at time of daily phone calls

Time frame: 3 days

Sensory and motor deficits (ability to move fingers and numbness of fingers) as reported to study staff.

Time frame: 3 days

Catheter site discomfort, leakage at catheter site, and catheter related pain on the 0-10 rating scale, where 0=no pain and 10=worst imaginable pain, as reported to study staff during phone calls.

Time frame: 3 days

Data from ClinicalTrials.gov

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