Comparison 1 Plane-2 Injection and 2 Plane-2 Injection Ultrasound-guided Supraclavicular Brachial Plexus Block

Gachon University Gil Medical Center70 enrolled

Overview

The supraclavicular block can provide effective surgical anesthesia of the forearm and hand. There have been many different approaches to ultrasound-guided supraclavicular brachial plexus block (US-SCBPB) according to the needle injection site (e.g. corner pocket approach, cluster approach) or number of needling (single or double injection). Numerous studies demonstrates good results (e.g. faster onset time) when using double injections rather than single injection. But double injection does not guarantee complete sensory block because ulnar nerve tends to be spared by its anatomical location.

The investigators hypothesized that double injection in different plane (we call this new approach as a 2 plane-2 injection approach;2P2I) would overcome the weakness of the existing double injection in same plane (we call this approach as a 1 plane-2 injection approach;1P2I) like "ulnar nerve sparing effect", and could have a good results (e.g. shortening the onset time or increasing rate of all four nerves block). Because 2P2I can achieve an effect of a "tridimensionally administered LA", rather 1P2I only achieve an effect of a " two-dimensionally administered LA".

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Masking

DOUBLE

Enrollment

Conditions

Radius Fractures

Interventions

lidocaine mixed with epinephrineDRUG

2P2I group and 1P2I group use the same LA (1.5% lidocaine mixed with 1:200,000 epinephrine). But 2P2I group is injected LA at equally divided doses (15 mL at a time) with the up-down direction at the different puncture site. 1P2I group is injected LA at equally divided doses with the up-down direction at the same puncture site.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * all patients anticipating surgery of the wrist or hand * age: 18 to 80 years * American Society of Anesthesiologists physical status (ASA): I or II Exclusion Criteria: * neuropathy in the operated limb * ASA greater than III * coagulation disorders * known allergy to local anesthetics * local infection at the puncture site * chronic obstructive pulmonary disease or respiratory failure * pregnancy or breast-feeding * prior surgery in the supraclavicular region * BMI ≥ 35 kg/㎡ * uncooperative patients * patients' refusal

Outcomes

Primary Outcomes

rate of complete sensory blockade of all 4 nerves

If the sensory on the site under the control of all 4 (median, radial, ulnar, musculocutaneous) nerves is checked as 0 (just feeling of touch or none ) separately, it is considered as a complete sensory block. the investigators compare the rate of complete sensory block with 2P2I group and 1P2I group.

Time frame: check 30 minutes after performing the block at 5-minute intervals (from date of randomization until the date of first documented progression)

Secondary Outcomes

the onset time

The investigators compare the onset time (time required to obtain of a sensory block at the surgical incision site) with 2P2I group and 1P2I group.

Time frame: check 30 minutes after performing the block at 5-minute intervals(from date of randomization until the date of first documented progression)