Patients will be randomized to one of two groups: 1. Extrafascial injection group: Ultrasound-guided supraclavicular brachial plexus block with 2 injections of local anaesthetic, deposited at the exterior of the fascial sheath that surrounds the nerves 2. Intrafascial injection group: Ultrasound-guided supraclavicular brachial plexus block with 2 injections of local anaesthetic, deposited at the interior of the fascial sheath that surrounds the nerves
The study will be proposed to all patients undergoing formarm or hand surgery under axillary brachial plexus block. Patients will be randomized to one of two groups. The first group - extrafascial injection group - will receive an ultrasound-guided supraclavicular brachial plexus block whereby the local anesthetic will be deposited at the exterior of the fascial sheath that surrounds the nerves. The second group - intrafascial injection group - will receive an ultrasound-guided supraclavicular brachial plexus block whereby the local anesthetic will be deposited at the interior of the fascial sheath that surrounds the nerves. All patients will receive the same type and amount of local anesthetic: 30 ml of a mixture of ropivacaine 0.5 % + mepivacaine 1 %. The primary outcome is the rate of hemidiaphragmatic paresis 30 minutes after the block procedure, assessed with ultrasound. Secondary outcomes are: rate of hemidiaphragmatic paresis 2 hours after surgery, assessed with ultrasound, bedside spirometry before the supraclavicular block, 30 minutes after the block and 2 hours after surgery, rate of successful block 30 minutes after the block , duration of sensory and motor block, pain scores at rest and on movement at 24 h postoperatively, cumulative postoperative opioid consumption at 24 hours postoperatively and patient satisfaction with overall anesthetic management. These outcomes are further defined in the section below.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
50
Extrafascial injection of local anaesthetic under ultrasound guidance
Intrafascial injection of local anaesthetic under ultrasound guidance
Hopital du Valais
Sion, Switzerland
Hemidiaphragmatic paresis 30 minutes after the block
Rate of hemidiaphragmatic paresis 30 minutes after the block procedure, assessed with ultrasound
Time frame: 30 minutes after the block
Hemidiaphragmatic paresis 2 hours after surgery
Rate of hemidiaphragmatic paresis 2 hours after surgery, assessed with ultrasound
Time frame: 2 hours after surgery
Bedside spirometry before the block (baseline)
Bedside spirometry before the supraclavicular block
Time frame: 30 minutes before the block
Bedside spirometry after 30 minutes after the block
Bedside spirometry after the supraclavicular block
Time frame: 30 minutes after the supraclavicular block
Bedside spirometry 2 hours after surgery
Bedside spirometry 2 hours after surgery
Time frame: 2 hours after surgery
Rate of successful block 30 minutes after the block
Presence of a surgical block according to a validated composite scale
Time frame: 30 minutes after the block
Block-related side effects
paresthesia, dyspnea, Horner's syndrome, hoarseness, hematoma, infection
Time frame: 24 h postoperatively
Pain during block procedure
Pain score (numeric rating scale, 0-10, with 0=no pain, 10=worst imaginable pain)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: During block procedure
Pain at rest and on movement
Pain score (numeric rating scale, 0-10, with 0=no pain, 10=worst imaginable pain)
Time frame: 24 h postoperatively
Postoperative opioid consumption
Cumulative postoperative opioid consumption
Time frame: 24 hours postoperatively
Patient satisfaction with overall anesthetic management
numeric rating scale, 0-10)
Time frame: 24 hours postoperatively