Ultrasound-guided Infraclavicular Block With Lidocaine or Ropivacaine for Closed Reduction of Distal Radius Fractures

Nordsjaellands Hospital67 enrolled

Overview

To investigate the feasibility of the lateral infraclavicular plexus brachialis (LIC) block for acute closed reduction of distal radius fractures, the investigators will compare the pain-relieving and muscle-relaxing properties of the LIC block with short- and long-acting local anesthetics in different concentrations but at the same volume. In addition to motor and sensory blockade during repositioning, feasibility will also be assessed by other patient-related and block-related factors, as well as by factors related to the repositioning and plastering procedure.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Enrollment

Conditions

Distal Radius Fractures Lidocaine Ropivacaine Fracture Dislocation Closed Reduction of Fracture and Application of Plaster Cast

Interventions

Ropivacaine 0.2% Injectable SolutionDRUG

30 ml of Ropivacaine 0.2% = 60 mg ropivacaine

Lidocaine epinephrineDRUG

30 ml of Lidocaine 1% with 5 μg/ml epinephrine = 300 mg lidocaine + 150 μg epinephrine

Ropivacaine 0.5% Injectable SolutionDRUG

30 mL of Ropivacaine 0.5% = 150 mg Ropivacaine

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: Patients who have given written informed consent to participate in the study after having understood it, as well as: • Having a distal radius fracture requiring closed reduction Exclusion Criteria: Patients who meet one or more of the following criteria will be excluded from participating in the study: * BMI \> 40 kg/m2 * Weight \< 50 kg * Age \< 18 years * American Society of Anesthesiologists (ASA) physical status classification system grade \>3 * Allergy to experimental drugs * Patients who cannot cooperate with the examinations or treatment * Patients who do not understand or speak Danish * Patients with peripheral or central neurological disease or nerve damage with neurological effect on the upper extremity, where closed reduction is required

Outcomes

Primary Outcomes

Block success

The incidence of successful blockade 45 minutes after block performance. The following 4 nerves will be tested: radial, musculocutaneous, ulnar and median nerves. Sensory blockade assessment: * A 3-point scale is used for cold sensation assessment: 1 point = normal sensation of cold, 2 points = reduced sensation of cold and 3 points = no cold sensation. * A complete sensory blockade is defined as all four nerves obtaining 3 points (no cold sensation). Motor blockade assessment: * Assessment is done using a 4-point Manual Muscle Testing Scale: 3 points = no difference, the movement against resistance is possible, 2 points = a slight difference, the movement against slight resistance is possible, 1 point = movement is significantly compromised, 0 points = paralysis. * A complete motor blockade is defined as all four nerves obtaining: 1 point or 0 points. Successful blockade: • Complete sensory and motor blockade 45 minutes after block performance.

Time frame: 45 minutes after block performance