Three Techniques for Ultrasound Guided Axillary Brachial Plexus Block

N/AUnknownNCT02073383

Federal University of São Paulo313 enrolled

Overview

The brachial plexus block is an anesthetic technique often used for surgical procedures of the upper limb. The brachial plexus block through the axilla (BPVA) is one of the techniques most commonly used to obtain regional anesthesia of the upper limbs, being performed by anesthesia of the terminal branches of the brachial plexus, which would be the ulnar, median, radial and musculocutaneous nerves. With the aid of ultrasound , two techniques can be used to perform the BPVA . The first , known as multiple puncture technique , the local anesthetic is deposited around each nerve that want to block . This technique is most commonly used to perform the BPVA . The second technique , known as 2 injections , local anesthetic is deposited below the axillary artery and around the musculocutaneous nerve . This technique has been proposed to try to reduce the execution time of anesthesia . Studies actually show that the technique of 2 injections showed less time to perform the block, with the same success rate. However, the technique of 2 injections showed a longer latency and higher rate of vascular puncture . (14) In order to perform a procedure with shorter execution time , without changing the latency, success rate and ensuring patient safety , the investigators designed this protocol to evaluate three techniques for performing the ultrasound- guided axillary brachial plexus block.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

313

Conditions

Hand Surgery

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Informed consent signed by the patient (IC) * Indication for brachial plexus block for anesthesia and analgesia in candidates for hand surgical procedures * ASA physical status I, II or III according to the American Association of Anesthesiology. Exclusion Criteria: * Cognitive impairment or psychiatric disease * Active infection condition at the puncture site of the block * Bleeding disorders * History of allergy to bupivacaine.

Outcomes

Primary Outcomes

The primary outcome is to compare the efficacy of the three different techniques for ultrasound guided axillary brachial plexus block

The brachial plexus block is performed through the axilla , with the aid of ultrasound and a peripheral nerve stimulator with the patient in the supine position. The needle that will be used is 22G x 50 mm . After disinfection and skin antisepsis with chlorhexidine , tha puncture site will be infiltrated with 1% lidocaine . Furthermore, musculocutaneous nerve will be blockade with 10 ml of 0.375% bupivacaine for all patients. Patients will be divided into three groups : Group A: 30 ml of 0.375% bupivacaine will be injected around the artery . If this were a clock, would deposit 7,5 ml of anesthetic in positions 0, 3, 6 and 9 . Group 2 injections : 30 ml of bupivacaine 0.375 % below the artery will be injected in the 6 o'clock position . Group M : 10 ml of bupivacaine 0.375 % will be injected

Time frame: The primary outcome will be measured at the same day of the procedure.

Secondary Outcomes

Block Latency

Latency time of the blockade , defined as the time between the end of injection of local anesthetic will be noted.

Time frame: 30 minutes