This study evaluates the effects of T2 paravertebral block block improving interscalene brachial plexus block and superficial cervical plexus block on the relief of pain intensity during elderly proximal humerus fracture fixation surgery. The brachial plexus and cervical plexus block(IC block) will be performed in half of participants, while the T2 paravertebral block combined with IC block will be performed in the other half.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
80
Ultrasound guided T2 thoracic paravertebral block is added in ICTP group. After interscalene brachial plexus block and superficial cervical plexus block have been administrated, selective 2nd thoracic nerve root(T2) will be blocked with 10 ml of 0.25% ropivacaine(naropin).
An ultrasound-guided IC block using an ultrasound machine (Sonosite, USA), and an linear array probe with a sterile cover and a 22G(Gauge) block needle is performed. An in-plane approach, advancing the needle along the longitudinal axis of the ultrasound transducer and visualizing the entire shaft is employed. Twenty ml of 0.375% ropivacaine(naropin) is injected around brachial plexus and 10 ml of 0.25% ropivacaine around superficial cervical plexus.
Shanghai Jiao Tong University Affiliated Sixth People's Hospital
Shanghai, Shanghai Municipality, China
Success Rate(Ability to Proceed With Surgery Without the Need for Intravenous Narcotics, General Anaesthesia, Rescue Blocks or Local Infiltration by the Surgeon)
Success rate - was equivalent to surgical anesthesia, defined as the ability to proceed with surgery without the need for intravenous narcotics, general anaesthesia, rescue blocks or local infiltration by the surgeon.
Time frame: throughout the operation duration, an average of 2 to 3 hours
Assessment of Sensory Blockade
Sensory blockade graded from 0 to 2(0= normal sensation, 1= decreased sensation and 2= no perception) by applying pinprick and cold test to the different parts of shoulder
Time frame: 20 minutes after all the nerve block operations have been finished
Proportion of Participants Completed the Procedure With Remifentanil
When the primary outcome of the participant is assessed by "failure" during the surgery, 0.25μg/kg/min remifentanil will be given via intravenous infusion. Two minutes later, the procedure will continue if the participant can tolerate the pain.
Time frame: throughout the operation duration, an average of 2 to 3 hours
Proportion of Participants Conversed Into General Anesthesia(Laryngeal Mask Airway,LMA)
When the primary outcome of the participant is assessed by "failure" during the surgery, 0.25μg/kg/min remifentanil will be given via intravenous infusion. Two minutes later, if the participant cannot tolerate the pain, a general anesthesia with LMA will be given.
Time frame: throughout the operation duration, an average of 2 to 3 hours
Cumulative Doses of Intraoperative Vasoactive Medications (Urapidil,Atropine, Ephedrine)
Cumulative doses of vasoactive drugs required such as urapidil,atropine, ephedrine during the surgery.
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Time frame: At the end of surgical procedure(an average of 2 to 3 hours)
Cumulative Doses of Intraoperative Vasoactive Medications (Deoxyepinephrine)
Cumulative doses of intravenous deoxyepinephrine required during the surgery.
Time frame: At the end of surgical procedure(an average of 2 to 3 hours)
Complications Related With Anesthesia
Presence or absence of local anesthetic systemic toxicity, pneumothorax, and epidural block, total spinal block, hematoma
Time frame: within 24 hours since the nerve block finished
Intraoperative Adverse Reactions (Including Hypertension, Hypotension, Bradycardia, Tachycardia or Dyspnea)
Number of participants with hypertension, hypotension, bradycardia, tachycardia or dyspnea during the surgery.
Time frame: throughout the operation duration, an average of 2 to 3 hours