Lateral Sagittal vs Costoclavicular Approach for Ultrasound-Guided Infraclavicular Block

Ondokuz Mayıs University109 enrolled

Overview

An ultrasound-guided infraclavicular block performed with the costoclavicular (CC) approach and the lateral sagittal (LS) approach will be compared in patients scheduled for forearm and hand surgery.

The CC approach is a recently introduced infraclavicular approach that targets three cords (medial, lateral and posterior) located lateral to the axillary artery in the costoclavicular space. Cords in this space are located more superficially than with the classical approach at the lateral infraclavicular fossa and are clustered but maintain a consistent anatomical relationship with each other. Patients will be divided into two groups: Group LS: Ultrasound-guided infraclavicular block - lateral sagittal approach (20 ml 0.5% bupivacaine) Group CC: Ultrasound-guided infraclavicular block - costoclavicular approach (20 ml 0.5% bupivacaine)

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

109

Conditions

Anesthesia, Local Nerve Block Brachial Plexus Block

Interventions

Lateral Sagittal ApproachPROCEDURE

The US probe will be located medial to the coracoid process in the sagittal plane in the infraclavicular region, and then three cords of the brachial plexus will be viewed. Using the in-plane technique, bupivacaine 0.5% will be administered around the posterior cord (7ml), lateral cord (7ml), and medial cord (6ml).

Costoclavicular ApproachPROCEDURE

The US probe will be placed parallel to the clavicle in the midclavicular area and tilted toward the cephalad and the axillary artery, and three cords will be viewed. A needle will be forwarded from lateral to medial with the in-plane technique, and 20 ml of bupivacaine 0.5% will be administered at the center of the three cords.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Age 18 years to 65 years * Patients scheduled for elective forearm and hand surgeries * Patients with American Society of Anesthesiologists (ASA) 1-3 Exclusion Criteria: * Patients not consenting/unwilling to participate * Age \<18 years or \>65 years * Patients with ASA 4 * Obesity (BMI \>30 kg/m2) * Regional anesthesia contraindicated (thrombocytopenia, infection at injection site) * Severe renal, cardiac, or hepatic disease * History of hypersensitivity or allergy to local anesthetics * History of opioid or steroid use for more than 4 weeks * History of psychiatric disorders * Analgesic treatment in the last 48 hours preoperatively * Operations lasting less than 60 minutes and more than 180 minutes * Patients who converted to general anesthesia

Locations (1)

Ondokuz Mayis University

Samsun, Atakum, Turkey (Türkiye)

Outcomes

Primary Outcomes

Performance time of the operator

Time elapsed from when the needle enters the skin after an optimal view is obtained on ultrasound until the block needle exits the skin after the procedure is completed.

Time frame: During the block procedure

Duration of start of motor block

Time from when a Lovett score of 5 is seen in at least 1 of 3 cords in the patient extremity on which the operation is being performed, following local anesthetic injection. Lovett rating scale: 6 = normal muscle strength, 5 = slightly decreased muscle strength, 4 = significantly decreased muscle strength, 3 = slight loss of movement, 2 = significant loss of movement, 1 = near total loss of movement, and 0 = total paralysis. Motor block cord myotomes will be evaluated as medial cord (thumb adduction = ulnar nerve), lateral cord (elbow flexion = mucocutaneous nerve), and posterior cord (wrist extension = radial nerve).

Time frame: 45 minutes after the block procedure

Start time of the nervous block

Time from the local injection to when a pin-prick test yields no response in at least 1 of 3 cords in the extremity on which the operation is being performed.

Time frame: 45 minutes after the block procedure

Secondary Outcomes

Time of sensory block

Time when the patient describes pain or when the pin-prick test yields a positive response in the extremity on which the operation is performed.

Time frame: Postoperative Day 1

Time of motor block

Time when Lovett score is 2 at any of the 3 dermatomes of the extremity on which the operation is being performed. Lovett rating scale 6 = normal muscle strength, 5 = slightly decreased muscle strength, 4 = significantly decreased muscle strength, 3 = slight loss of movement, 2 = significant loss of movement, 1 = near total loss of movement, and 0= total paralysis. Motor block cord myotomes will be evaluated as medial cord (thumb adduction=ulnar nerve), lateral cord (elbow flexion= mucocutaneous nerve), and posterior cord (wrist extension=radial nerve).

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.