Peripheral nerve blocks are routinely used and highly successful for intra-operative anesthesia and post-operative pain management. Nerve blocks are guided using either neurostimulation as a means to localize the right nerve or by ultrasound guidance or combining the 2 methods. The purpose of this study is to assess whether electrical stimulation improves nerve block quality, beyond its simple purpose of nerve localization.
The investigators wish to understand how electrical stimulation can affect local anesthetic disposition when performing a peripheral nerve block. By studying this subject, the investigators open possibilities for improvement on many levels: increasing the efficacy of the nerve block allows for a reduced onset time, reduced incidence of incomplete block and prolonged duration of the local anesthetics. This allows for patients to fully benefit from the analgesic properties of the nerve block, allows for a decrease in delays for the operating room readiness, and a decrease in the amount of medication needed for a successful nerve block. This will decrease side effects and risks of the nerve blocks. Overall better post-surgical pain control may decrease risks for developing chronic post-operative pain, a major post-operative complication. The results of this study will open the door to novel approaches to manage acute post-operative pain.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
DIAGNOSTIC
Masking
TRIPLE
Enrollment
82
Nerve stimulator that is traditionally used for nerve localization during block placements.
Stimulator will be placed and turned on, but the grounding electrode will not be connected to prevent nerve stimulation.
Stanford University Hospital
Stanford, California, United States
Onset of sensory block
Determining time when patient experience first symptoms of local anesthetic action on the upper trunk distribution (median or musculo cutaneous nerve)
Time frame: Within 1 hour after the block placement
Onset of motor block
Determining time when patient start loosing strength at the musculo cutaneous nerve (biceps brichialis muscle)
Time frame: Within 1 hour after the block placement
Duration of sensory block
Time after surgery at which the patient recovers first sign of sensory function
Time frame: up to 7 days after surgery
duration of motor block
Time after surgery at which the patient recovers a biceps brachialis function
Time frame: up to 7 days after surgery
When patient experience first pain
Time after surgery at which the patient experience first sign of pain at the surgical site
Time frame: up to day 7 post operatively
Time of first opioid taken
When the first opioid was taken
Time frame: within the first 7 days after surgery
Opioid usage at day 1
Milligram of morphine equivalent
Time frame: at post operative day 1
opioid usage assessment at day 7
Milligram of morphine equivalent taken
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Time frame: Within the Post operative day 1 and 7
Opioid usage assessment at day 28
milligram of morphine equivalent assess at day 28
Time frame: usage between post operative day 7 and 28
Last opioid usage after day 28
When was the last day of opioid usage
Time frame: Assessment within 1 year
Amount of opioid usage after 28 days
Milligram of morphine equivalent use weekly after 28 days
Time frame: 28 days to 1 year after surgery
Patient satisfaction
Assessing patient's satisfaction, using the standardized -Quality of Recovery 15- at post operative day 7, 28 and 1 year. Each item count on a 0-10 scale where O is worse and 10 is best PART A How have you been feeling in the last 24 hours? (0 to 10, where 0 = none of the time \[poor\] and 10 = all of the time \[excellent\] Q.1 Able to breathe easily Q.2 Been able to enjoy food Q.3 Feeling rested Q.4 Have had a good sleep Q.5 Able to look after personal toilet and hygiene unaided Q.6 Able to communicate with family or friends Q.7 Getting support from hospital doctors and nurses Q.8 Able to return to work or usual home activities Q.9 Feeling comfortable and in control Q.10 Having a feeling of general well-being PART B Have you had any of the following in the last 24 hours? (10 to 0, where 10 = none of the time \[excellent\] and 0 = all of the time \[poor\]) Q.11 Moderate pain Q.12 Severe pain Q.13 Nausea or vomiting Q.14 Feeling worried or anxious Q.15 Feeling sad or depressed
Time frame: At Post Operative day 7, 28 and 1 year
General satisfaction
General satisfaction on a scale from 1-5 (extremely unsatisfied, unsatisfied, neutral, satisfy, extremely satisfied)
Time frame: at post operative day 7, 28 and 1 year