Supraclavicular Block vs Retroclavicular Block: Incidence of Phrenic Nerve Paralysis

Brigham and Women's Hospital44 enrolled

Overview

The aim of this study is to evaluate differences between ultrasound guided supraclavicular versus retroclavicular brachial plexus blocks: two similar brachial plexus nerve block techniques that differ in their needle trajectory and injection site.

To date, there has not been a study that has compared clinically the retroclavicular brachial plexus block to the supraclavicular brachial plexus block or other brachial plexus blocks. The aim of this study is to evaluate differences between ultrasound guided supraclavicular versus retroclavicular brachial plexus blocks, with primary focus on the incidence of diminished ipsilateral hemidiaphramatic excursion (ipsilateral phrenic nerve blockade). We will also evaluate differences between the two techniques in the success of producing surgical anesthesia, procedural time to perform the block (including imaging time and needling time), block onset time, ease of quality ultrasound needle visualization, and incidence of paresthesias, vascular puncture and pneumothorax. Lastly, we will observe and compare the distribution of motor and sensory blockade of the two techniques

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

Conditions

Phrenic Nerve Paralysis

Interventions

Supraclavicular vs Retroclavicular Nerve BlockPROCEDURE

An ultrasound-guided supraclavicular or retroclavicular nerve block with 30 ml of 0.5% ropivicaine will be performed on patients scheduled for lower arm surgery; 25 ml to be delivered to the brachial plexus and 5 ml to the intercostal nerve

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. patients scheduled for lower arm surgery 2. patients aged 18 years or older 3. patients ASA class I-III Exclusion Criteria: 1. Patients unable to cooperate or consent to the study 2. pre-existing neuropathy 3. significant pulmonary disease 4. contralateral phrenic nerve or diaphragmatic dysfunction 5. allergy to local anesthetics 6. infection at needle insertion site 7. history of coagulopathy 8. BMI \> 40 kg/m2

Locations (1)

Kamen Vlassakov

Boston, Massachusetts, United States

Outcomes

Primary Outcomes

Incidence of IIpsilateral Diaphragmatic Paresis

As evidence by ipsilater diagphragmatic excursion measured by Mmode ultrasound

Time frame: 30 minutes post block, then postoperatively

Secondary Outcomes

Anesthetic and analgesic efficacy

Block success will be defined as onset of acceptable sensory and motor blockade

Time frame: 30 minutes post block, then postoperatively

Procedural times (imaging time and needling time), onset time, ease of placement, and block duration

Ultrasonographic block imaging times (time between ultrasound probe placement on the patient and satisfactory image of target anatomy acquisition. needling time (time between needle insertion into the skin and the end of local anesthetic injection through the block needle), onset and duration of sensory block, and proceduralist's rating of ease of block performance will be measured.

Time frame: at the time of block

Complication rates

Rates of vascular puncture, pneumothorax and paresthesias will be recorded

Time frame: 1 day

Nerve block distribution

measured through sensation (cold and pin prick) over dermatomes of the brachial plexus

Time frame: 30 minutes post block

Data from ClinicalTrials.gov

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