Infraclavicular block has taken its place in the literature as a proven technique in the anesthetic management of upper extremity surgeries. Compared to general anesthesia; The prominent advantages of regional anesthesia are that it provides longer perioperative pain control, reduces the incidence of postoperative nausea and vomiting, reduces opioid consumption and reduces the cost of hospitalization. The widespread use of ultrasonography (USG) in the last two decades has facilitated the application of the method and allowed the investigation of different injection methods. Regional blocks are planned according to the surgery to be performed. For anesthesia of arm, forearm and hand operations; brachial plexus can be blocked in the axillary, infraclavicular, supraclavicular or interscalene region. The infraclavicular technique, on the other hand, is roughly divided into three types: costoclavicular lateral, costoclavicular medial and paracoracoid (Lateral sagittal). The image obtained by placing the ultrasonography probe in the relevant anatomical region serves as a guide for the orientation of the peripheral block needle and performing the intervention by observing the vascular structures in the existing region provides a great advantage in terms of patient safety. In this study, we aimed to examine 3 different infraclavicular block methods; lateral costoclavicular, medial costoclavicular and lateral sagittal (Paracoracoid) approach, in terms of ease of application and motor/sensory block efficiency. Our hypothesis is that the sensory block will begin in a shorter time with costoclavicular methods compared to the lateral sagittal method. We are also planning to compare performance difficulties (needle maneuver numbers, subjective block exertion, block performance time etc.) for each type of intervention.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
56
Named after the anatomical site; patients will be applied infraclavicular brachial plexus block with costoclavicular lateral, costoclavicular medial or lateral sagittal approach.
Meltem Savran Karadeniz
Istanbul, Fatih, Turkey (Türkiye)
Sensory block onset time
Separately evaluated sensorial examination for four nerves (n. medianus, n. radialis, n. ulnaris, n. musculocutaneus), a total number of 6 points is accepted as "settled sensory block". 0= absent sensory block (feels pain), 1= partial sensory block (feels touch), 2= complete sensory block (no sense). Patients will be evaluated every 5 minutes after intervention.
Time frame: Up to 45 minutes.
Ideal USG guided brachial plexus cords visualization / needle pathway planning time
Practitioner's ideal image acquisition time
Time frame: Up to 15 minutes
Needle tip and shaft imaging visualization difficulty
Likert Scale: 1-5 (1:very hard; 5: very easy)
Time frame: Up to 15 minutes
Requirement of additional maneuver due to insufficient local anesthetic distribution
Extra needle redirection to cover neural structure
Time frame: Up to 15 minutes
Total procedure difficulty according to anesthesiologist
Likert Scale: 1-5 (1:Very hard; 5: Very easy)
Time frame: Up to 15 minutes
Patient number requiring rescue analgesics
If a ≥ 20% increase above preinduction values in MAP or HR was observed during the perioperative period, additional fentanyl dose (1 μg/kg) was applied intravenously
Time frame: Intraoperative 2-4 hours
Motor blockade onset time
Separately evaluated motor examination for four nerves (n. medianus, n. radialis, n. ulnaris, n. musculocutaneus), a total number of 6 points is accepted as "settled motor block". 0= absent motor block (Full movement), 1= partial motor block (free movement only), 2= complete motor block (no movement). Patients will be evaluated every 5 minutes after intervention.
Time frame: Up to 45 minutes
Time to postoperative first pain
Time to first intravenous analgesic administration which is requested by the patient
Time frame: Up to 24 hours
Patient number requiring postoperative additional analgesic
Number of patients who require paracetamol (15 mg/kg) and tramadol (1mg/kg) IV
Time frame: Up to 24 hours
Complications / Side effects
Possible complications related to infraclavicular block (such as vascular puncture, hematoma, pneumothorax, diaphragma palsy...)
Time frame: Up to 24 hours
Patient satisfaction
Satisfaction score: 0: very unsatisfied 3: very satisfied
Time frame: Up to 24 hours
Surgeon satisfaction
Satisfaction score: 0: very unsatisfied, 3: very satisfied
Time frame: Up to 24 hours
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