The Simultaneous Use of Supraclavicular and Distal Blocks

Phase 4CompletedNCT01989312

Ankara University75 enrolled

Overview

The aim of this study is to compare the combined ultrasound-guided supraclavicular brachial plexus block and distal median, radial, and ulnar nerve blocks, with supraclavicular block alone. Sixty two patients undergoing upper extremity surgery will be randomized to supraclavicular only (Group S, n=31) or supraclavicular + distal (Group SD, n=31) group. Patients in group S will receive 32 mL of lidocaine 1.5% + epinephrine 5µg/mL and in group SD receive 20 mL of lidocaine 1.5% + epinephrine 5µg/mL followed by a distal median, radial, and ulnar nerve blocks using 50:50 mixture of lidocaine 2% + levobupivacaine 0.5% (4 mL/nerve). Sensory and motor block of the ulnar, median, radial and musculocutaneous nerves will be assessed every 5 minutes starting at the 10th minutes. The imaging, needling and performance times will be recorded. Also the onset and anesthesia related times, need for analgesic and first analgesic time will be noted.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Masking

QUADRUPLE

Enrollment

Conditions

Orthopaedic Disorders Nerve Block Anaesthesia

Interventions

intravenous cannulation.PROCEDURE

A 18-or 20-gauge intravenous (iv) catheter was placed to the contralateral arm according to the surgical site

Supraclavicular block and ultrasound-guided ulnar, median and radial nerve blocks.PROCEDURE

Supraclavicular block with 20 mL of lidocaine 1.5% + epinephrine 5µg/mL and the addition of ultrasound-guided ulnar, median and radial nerve blocks. For that 12 mL of local anesthetic solution of a 50:50 mixture of lidocaine 2% and levobupivacaine 0.5% (4 mL/nerve) was used.

Intravenous cannulation.DEVICE

A 18-or 20-gauge intravenous (iv) catheter was placed to the contralateral arm according to the surgical site

Routine ASA monitoringDEVICE

Monitorization with ECG, noninvasive blood pressure and spO2.

Premedication midazolamDRUG

Premedication with 0.03 mg/kg midazolam iv

LidocaineDRUG

EpinephrineDRUG

LevobupivacaineDRUG

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18 and 80 years old patient * American Society of Anesthesiologists (ASA) physical status I-III * Scheduled for elective hand and forearm surgery Exclusion Criteria: * patient refusal * preexisting neuropathy * coagulopathy * allergy to agents used * pregnancy * body mass index \> 35 kg/m2 * chronic obstructive pulmonary disease * infection or previous surgery in the supraclavicular area * systemic infection

Outcomes

Primary Outcomes

The time required after a supraclavicular block alone or a supraclavicular block combined with distal blocks, to achieve a sensory and motor block needed for surgery.

The onset time of supraclavicular plexus block and the onset time of supraclavicular block combined with distal median, radial, and ulnar nerve blocks will be followed up. The time needed to achieve a surgical block will be assessed in both groups. The difference between the 2 groups will be compared and analysed. For this an investigator blinded to the group allocation will evaluate the sensorial pinprick and motor blocks of the ulnar, median, radial and musculocutaneous nerves every 5 minutes starting at the 10th minutes until 30th minutes.

Time frame: All patients will be followed up during the block procedure and during the surgery. Also, after the surgery patients will be followed up to 7 days postoperatively.