Ultrasound-Guided Axillary or Infraclavicular Nerve Block for Upper Limb Surgery

NCT ID: NCT00724035

Last Updated: 2009-07-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

52 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-05-31

Study Completion Date

2009-07-31

Brief Summary

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This study aims to detect differences in onset time of brachial plexus (i.e., arm) anesthesia using two different nerve block techniques.

Using ultrasound guidance, axillary (i.e., at the armpit) and infraclavicular (i.e., below the collarbone) blocks will be performed to patients undergoing upper limb surgery.

The investigators will analyze how long it takes for anesthesia to be adequate for pain-free surgery, thus determine the optimal technique for this kind of surgery.

Detailed Description

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Real-time ultrasound guidance has substantially reduced the risk of pneumothorax and/or vascular puncture during infraclavicular brachial plexus blocks. The role of this technique has thus been expanded to overlap those procedures for which an axillary nerve block would be commonly considered as first choice.

A reference block for upper limb surgery thanks to its safety profile and clinical efficacy, the axillary approach may be more painful or unpleasant for some patients.

The investigators aim to determine possible differences in onset time and patient acceptance between the two techniques.

Conditions

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Upper Extremity Orthopedic Surgery Trauma Forearm Injuries Nerve Block

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Infraclavicular

This group will receive an ultrasound-guided infraclavicular brachial plexus block.

Group Type EXPERIMENTAL

Midazolam

Intervention Type DRUG

Procedural sedation before the execution of the block.

* 0.03 mg/kg iv bolus

Ropivacaine

Intervention Type DRUG

0.75% (wt/vol) solution, 20 ml perineural injection

Fentanyl

Intervention Type DRUG

50 µg iv bolus prn for pain during surgery, up to 150 µg

General anesthesia

Intervention Type PROCEDURE

General anesthesia will be induced if pain during surgery develops which is intractable with iv fentanyl ≤150 µg.

Infraclavicular brachial plexus block

Intervention Type PROCEDURE

Blocks will be performed under high-resolution real-time ultrasound guidance.

Patients will be in the supine position. The linear transducer will be initially positioned between the middle and lateral third of the clavicle, scanning on a parasagittal plane.

The axillary artery and veins will then be sought for. We will try to visualize the three cords of the brachial plexus separately, and to inject local anesthetic around each of them. If this is not possible, the needle will be positioned cranially and posteriorly to the artery, and the injection will be made from there. A 20 G, 17°-bevel needle will be used for all blocks.

Axillary

This group will receive an ultrasound-guided axillary brachial plexus block.

Group Type ACTIVE_COMPARATOR

Midazolam

Intervention Type DRUG

Procedural sedation before the execution of the block.

* 0.03 mg/kg iv bolus

Ropivacaine

Intervention Type DRUG

0.75% (wt/vol) solution, 20 ml perineural injection

Fentanyl

Intervention Type DRUG

50 µg iv bolus prn for pain during surgery, up to 150 µg

General anesthesia

Intervention Type PROCEDURE

General anesthesia will be induced if pain during surgery develops which is intractable with iv fentanyl ≤150 µg.

Axillary brachial plexus nerve block

Intervention Type PROCEDURE

Blocks will be performed under high-resolution real-time ultrasound guidance.

Patients will be in the supine position. With the abducted arm flexed 90° at the elbow, the transducer will scan for the axillary artery in its short-axis. Individual nerves will be sought for around the artery.

A 22G, 17°-bevel needle will be advanced in-plane to inject aliquots of local anesthetic around each nerve structure up to the prescribed dose.

Interventions

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Midazolam

Procedural sedation before the execution of the block.

* 0.03 mg/kg iv bolus

Intervention Type DRUG

Ropivacaine

0.75% (wt/vol) solution, 20 ml perineural injection

Intervention Type DRUG

Fentanyl

50 µg iv bolus prn for pain during surgery, up to 150 µg

Intervention Type DRUG

General anesthesia

General anesthesia will be induced if pain during surgery develops which is intractable with iv fentanyl ≤150 µg.

Intervention Type PROCEDURE

Axillary brachial plexus nerve block

Blocks will be performed under high-resolution real-time ultrasound guidance.

Patients will be in the supine position. With the abducted arm flexed 90° at the elbow, the transducer will scan for the axillary artery in its short-axis. Individual nerves will be sought for around the artery.

A 22G, 17°-bevel needle will be advanced in-plane to inject aliquots of local anesthetic around each nerve structure up to the prescribed dose.

Intervention Type PROCEDURE

Infraclavicular brachial plexus block

Blocks will be performed under high-resolution real-time ultrasound guidance.

Patients will be in the supine position. The linear transducer will be initially positioned between the middle and lateral third of the clavicle, scanning on a parasagittal plane.

The axillary artery and veins will then be sought for. We will try to visualize the three cords of the brachial plexus separately, and to inject local anesthetic around each of them. If this is not possible, the needle will be positioned cranially and posteriorly to the artery, and the injection will be made from there. A 20 G, 17°-bevel needle will be used for all blocks.

Intervention Type PROCEDURE

Other Intervention Names

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Versed Benzodiazepine Premedication Sedation Naropin Local anesthetic Amide local anesthetic Opioid Analgesic Monitored anesthesia care Peripheral Nerve Block Regional Anesthesia Ultrasound Regional Anesthesia Peripheral nerve block Ultrasound

Eligibility Criteria

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Inclusion Criteria

* ASA Physical Status Class \<4
* Scheduled upper extremity orthopedic surgery

Exclusion Criteria

* Psychiatric or cognitive disorder
* Allergy to study drugs
* Contraindication to nerve block at the assigned site
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Parma

OTHER

Sponsor Role lead

Responsible Party

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University of Parma

Principal Investigators

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Guido Fanelli, MD

Role: STUDY_CHAIR

Section of Anesthesiology and Critical Care, Dept. of Surgical Sciences, University of Parma

Giorgio Danelli, MD

Role: PRINCIPAL_INVESTIGATOR

UO II Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria di Parma

Locations

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University Hospital / Azienda Ospedaliero-Universitaria

Parma, PR, Italy

Site Status

Countries

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Italy

Other Identifiers

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ANEST-ORT-02

Identifier Type: -

Identifier Source: org_study_id

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