Three Techniques for Ultrasound Guided Axillary Brachial Plexus Block

NCT ID: NCT02073383

Last Updated: 2014-02-27

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

313 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-08-31

Study Completion Date

2015-03-31

Brief Summary

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The brachial plexus block is an anesthetic technique often used for surgical procedures of the upper limb. The brachial plexus block through the axilla (BPVA) is one of the techniques most commonly used to obtain regional anesthesia of the upper limbs, being performed by anesthesia of the terminal branches of the brachial plexus, which would be the ulnar, median, radial and musculocutaneous nerves. With the aid of ultrasound , two techniques can be used to perform the BPVA . The first , known as multiple puncture technique , the local anesthetic is deposited around each nerve that want to block . This technique is most commonly used to perform the BPVA . The second technique , known as 2 injections , local anesthetic is deposited below the axillary artery and around the musculocutaneous nerve . This technique has been proposed to try to reduce the execution time of anesthesia . Studies actually show that the technique of 2 injections showed less time to perform the block, with the same success rate. However, the technique of 2 injections showed a longer latency and higher rate of vascular puncture . (14) In order to perform a procedure with shorter execution time , without changing the latency, success rate and ensuring patient safety , the investigators designed this protocol to evaluate three techniques for performing the ultrasound- guided axillary brachial plexus block.

Detailed Description

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Conditions

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Hand Surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Around Artery

Intervention Name: Axillary brachial plexus block

Group A: 30 ml of 0.375% bupivacaine will be injected around the artery . If this were a clock, would deposit 7,5 ml of anesthetic in positions 0, 3, 6 and 9 .

Group Type EXPERIMENTAL

Axillary brachial plexus block

Intervention Type PROCEDURE

Two injections

Group 2: 30 ml of bupivacaine 0.375 % below the artery will be injected in the 6 o'clock position .

Group Type EXPERIMENTAL

Axillary brachial plexus block

Intervention Type PROCEDURE

Perineural

Group Perineural : 10 ml of bupivacaine 0.375 % will be injected around the median, ulnar and radial nerves .

Group Type ACTIVE_COMPARATOR

Axillary brachial plexus block

Intervention Type PROCEDURE

Interventions

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Axillary brachial plexus block

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Informed consent signed by the patient (IC)
* Indication for brachial plexus block for anesthesia and analgesia in candidates for hand surgical procedures
* ASA physical status I, II or III according to the American Association of Anesthesiology.

Exclusion Criteria

* Cognitive impairment or psychiatric disease
* Active infection condition at the puncture site of the block
* Bleeding disorders
* History of allergy to bupivacaine.
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Federal University of São Paulo

OTHER

Sponsor Role lead

Responsible Party

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Leonardo Henrique Cunha Ferraro

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Federal University of São Paulo

São Paulo, São Paulo, Brazil

Site Status

Countries

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Brazil

References

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Thompson GE, Rorie DK. Functional anatomy of the brachial plexus sheaths. Anesthesiology. 1983 Aug;59(2):117-22. doi: 10.1097/00000542-198308000-00009.

Reference Type BACKGROUND
PMID: 6869868 (View on PubMed)

Klaastad O, Smedby O, Thompson GE, Tillung T, Hol PK, Rotnes JS, Brodal P, Breivik H, Hetland KR, Fosse ET. Distribution of local anesthetic in axillary brachial plexus block: a clinical and magnetic resonance imaging study. Anesthesiology. 2002 Jun;96(6):1315-24. doi: 10.1097/00000542-200206000-00009.

Reference Type BACKGROUND
PMID: 12170042 (View on PubMed)

DE JONG RH. Axillary block of the brachial plexus. Anesthesiology. 1961 Mar-Apr;22:215-25. doi: 10.1097/00000542-196103000-00010. No abstract available.

Reference Type BACKGROUND
PMID: 13720553 (View on PubMed)

Vester-Andersen T, Christiansen C, Sorensen M, Kaalund-Jorgensen HO, Saugbjerg P, Schultz-Moller K. Perivascular axillary block II: influence of injected volume of local anaesthetic on neural blockade. Acta Anaesthesiol Scand. 1983 Apr;27(2):95-8. doi: 10.1111/j.1399-6576.1983.tb01913.x.

Reference Type BACKGROUND
PMID: 6837255 (View on PubMed)

Groban L. Central nervous system and cardiac effects from long-acting amide local anesthetic toxicity in the intact animal model. Reg Anesth Pain Med. 2003 Jan-Feb;28(1):3-11. doi: 10.1053/rapm.2003.50014.

Reference Type BACKGROUND
PMID: 12567336 (View on PubMed)

Mather LE, Copeland SE, Ladd LA. Acute toxicity of local anesthetics: underlying pharmacokinetic and pharmacodynamic concepts. Reg Anesth Pain Med. 2005 Nov-Dec;30(6):553-66. doi: 10.1016/j.rapm.2005.07.186.

Reference Type BACKGROUND
PMID: 16326341 (View on PubMed)

Fredrickson MJ, Ball CM, Dalgleish AJ, Stewart AW, Short TG. A prospective randomized comparison of ultrasound and neurostimulation as needle end points for interscalene catheter placement. Anesth Analg. 2009 May;108(5):1695-700. doi: 10.1213/ane.0b013e31819c29b8.

Reference Type BACKGROUND
PMID: 19372356 (View on PubMed)

Gautier P, Vandepitte C, Ramquet C, DeCoopman M, Xu D, Hadzic A. The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. Anesth Analg. 2011 Oct;113(4):951-5. doi: 10.1213/ANE.0b013e31822b876f. Epub 2011 Aug 4.

Reference Type BACKGROUND
PMID: 21821517 (View on PubMed)

Renes SH, van Geffen GJ, Rettig HC, Gielen MJ, Scheffer GJ. Minimum effective volume of local anesthetic for shoulder analgesia by ultrasound-guided block at root C7 with assessment of pulmonary function. Reg Anesth Pain Med. 2010 Nov-Dec;35(6):529-34. doi: 10.1097/AAP.0b013e3181fa1190.

Reference Type BACKGROUND
PMID: 20975468 (View on PubMed)

Marhofer P, Schrogendorfer K, Wallner T, Koinig H, Mayer N, Kapral S. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks. Reg Anesth Pain Med. 1998 Nov-Dec;23(6):584-8. doi: 10.1016/s1098-7339(98)90086-4.

Reference Type BACKGROUND
PMID: 9840855 (View on PubMed)

Ponrouch M, Bouic N, Bringuier S, Biboulet P, Choquet O, Kassim M, Bernard N, Capdevila X. Estimation and pharmacodynamic consequences of the minimum effective anesthetic volumes for median and ulnar nerve blocks: a randomized, double-blind, controlled comparison between ultrasound and nerve stimulation guidance. Anesth Analg. 2010 Oct;111(4):1059-64. doi: 10.1213/ANE.0b013e3181eb6372. Epub 2010 Aug 12.

Reference Type BACKGROUND
PMID: 20705778 (View on PubMed)

Casati A, Baciarello M, Di Cianni S, Danelli G, De Marco G, Leone S, Rossi M, Fanelli G. Effects of ultrasound guidance on the minimum effective anaesthetic volume required to block the femoral nerve. Br J Anaesth. 2007 Jun;98(6):823-7. doi: 10.1093/bja/aem100. Epub 2007 May 3.

Reference Type BACKGROUND
PMID: 17478453 (View on PubMed)

Riazi S, Carmichael N, Awad I, Holtby RM, McCartney CJ. Effect of local anaesthetic volume (20 vs 5 ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. Br J Anaesth. 2008 Oct;101(4):549-56. doi: 10.1093/bja/aen229. Epub 2008 Aug 4.

Reference Type BACKGROUND
PMID: 18682410 (View on PubMed)

Bernucci F, Gonzalez AP, Finlayson RJ, Tran DQ. A prospective, randomized comparison between perivascular and perineural ultrasound-guided axillary brachial plexus block. Reg Anesth Pain Med. 2012 Sep-Oct;37(5):473-7. doi: 10.1097/AAP.0b013e3182576b6f.

Reference Type BACKGROUND
PMID: 22660484 (View on PubMed)

Imasogie N, Ganapathy S, Singh S, Armstrong K, Armstrong P. A prospective, randomized, double-blind comparison of ultrasound-guided axillary brachial plexus blocks using 2 versus 4 injections. Anesth Analg. 2010 Apr 1;110(4):1222-6. doi: 10.1213/ANE.0b013e3181cb6791. Epub 2010 Feb 8.

Reference Type BACKGROUND
PMID: 20142336 (View on PubMed)

Other Identifiers

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FUSaoPaulo - USG Guided Block

Identifier Type: -

Identifier Source: org_study_id

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