Randomized Controlled Trial of Ultrasound Guided Needle Placement Versus Nerve Stimulation for Coracoid Infraclavicular Brachial Plexus Block

NCT ID: NCT00326261

Last Updated: 2008-12-18

Basic Information

• Recruitment Status: COMPLETED
• Study Classification: OBSERVATIONAL

Brief Summary

Nerve blocks for arm and hand surgery provide many advantages for patients including excellent pain control and reduction in general anesthesia-related adverse effects. Infraclavicular block is possibly the best method for performing regional anesthesia of the arm because of the consistent anesthesia of the whole arm and low incidence of serious adverse effects. Normally the anesthetist uses nerve stimulation to identify nerves supplying the forearm and hand. Recent research has indicated that to improve success from 60% to 79% two types of muscle stimulation must be sought before injection of local anesthetic. This can be time consuming, requires a significant learning process, increases complications and leaves 21% of patients with inadequate anesthesia requiring supplementation or general anesthesia. More recently practitioners have been using ultrasound imaging to direct the needle and watch local anesthetic spread around the nerves. Preliminary reports have documented that this technique is associated with much greater success than the nerve stimulation method. However a good quality study comparing the dual-endpoint infraclavicular technique with an ultrasound-guided technique has not been performed. This randomized study aims to rectify this deficiency by determining if ultrasound-guided infraclavicular block has a significantly greater success than the current standard, dual end-endpoint nerve stimulation technique.

Conditions

Patients Undergoing Hand Surgery

Study Design

• Study Time Perspective: PROSPECTIVE

Interventions

Ultrasound compared to dual-endpoint nerve stimulator guided approach.

Intervention Type: PROCEDURE

Ultrasound

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Patients undergoing elective upper limb surgery at or below the elbow.
• Patients aged > 18 and < 80 years.
• ASA I-III.
• BMI < 35.

Exclusion Criteria

• Inability to read, write or speak English. (This is necessary because subjects will have to follow detailed instructions to allow testing of motor and sensory function. it is not feasible to have an interpreter present in the block room during performance of these procedures).
• Contraindication to brachial plexus block.
• Existing neurological deficit in the area to be blocked.
• Known loco-regional malignancy or infection.
• Coagulopathy.
• Allergy to local anesthetic agents.
• Chest or shoulder deformities.
• Severe respiratory disease.
• Healed but dislocated clavicle fracture.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

The Physicians' Services Incorporated Foundation

OTHER

Sponsor Role: collaborator

Canadian Anesthesiologists' Society

OTHER

Sponsor Role: collaborator

University Health Network, Toronto

OTHER

Sponsor Role: lead

Principal Investigators

Colin JL McCartney, MBChB FRCA FCARCSI FRCPC

Role: PRINCIPAL_INVESTIGATOR

University Health Network, Toronto Western Hospital

Locations

University Health Network, Toronto Western Hospital

Toronto, Ontario, Canada

Countries

Canada

References

Brull R, Lupu M, Perlas A, Chan VW, McCartney CJ. Compared with dual nerve stimulation, ultrasound guidance shortens the time for infraclavicular block performance. Can J Anaesth. 2009 Nov;56(11):812-8. doi: 10.1007/s12630-009-9170-2.

Reference Type: DERIVED

PMID: 19728002 (View on PubMed)

Other Identifiers

03-0126-AE

Identifier Type: -

Identifier Source: org_study_id