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Retroclavicular Approach vs Infraclavicular Approach for Brachial Plexus Block in Obese Patients

NCT ID: NCT02990702

Last Updated: 2016-12-13

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

PHASE4

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-01-31

Study Completion Date

2017-07-31

Brief Summary

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The retroclavicular approach for brachial plexus anesthesia requires an optimal angle between the needle and the ultrasound beam. Retroclavicular approach has already been proven effective and safe in the past. The general objective is to provide a formal comparison between the retroclavicular approach and coracoid infraclavicular approach for brachial plexus anaesthesia. This study should represent the differences between the two techniques.

Detailed Description

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Classic infraclavicular approach of the brachial plexus involves a needle puncture below the clavicle and advancing the needle with a 45-60 degree angle from cephalad to caudad. The aim is to advanced the block needle posterior to the axillary artery and to deposit the local anesthetic at that point, near the posterior cord. A "U" shaped spread around the artery should ensure distribution around all three cords. Ultrasound guidance is highly recommended and neurostimulation is optional.

The retroclavicular approach is a variant to this classical technique. Ultrasound probe is positioned initially below the clavicle in a manner similar to the classic approach but is then rotated in a clockwise fashion (right arm) or counter-clockwise fashion (left arm) for about 25-35 degrees. The puncture site is just behind the clavicle at the most lateral point available. If initial entry point is optimal, needle direction is then parallel to ultrasound probe. The final aim and position of block needle is identical to classical approach. Entry point ensures a parallel alignment of the needle and the ultrasound beam, thus enabling almost perfect visualization of both artery, cords and block needle. This is turn optimizes safety, rapidity of technique, efficiency and efficacy.

It is recognized that regional anesthesia is more difficult to perform in obese patients. Anatomic landmarks are harder to localize in this population and ultrasound guidance is more difficult because of the attenuation of the ultrasound beam by adipose tissue. The complication rate of regional techniques is also reported to be higher in the obese patient population.

Conditions

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Forearm Injuries Hand Injuries

Keywords

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Infraclavicular block Retroclavicular block Ultrasound

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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Ultrasound guided retroclavicular block

Ultrasound guided retroclavicular block group patients (Group R) will receive 30 cc %0.5 Bupivacaine

Group Type ACTIVE_COMPARATOR

Ultrasound guided retroclavicular block

Intervention Type OTHER

Ultrasound guided retroclavicular block for forearm or hand surgery

Ultrasound guided coracoid infraclavicular block

Intervention Type OTHER

Ultrasound guided infraclavicular block for forearm or hand surgery

Bupivacaine

Intervention Type DRUG

Ultrasound

Intervention Type DEVICE

Ultrasound guided infraclavicular block

Ultrasound guided coracoid infraclavicular block group patients (Group C) will receive 30 cc %0.5 Bupivacaine

Group Type ACTIVE_COMPARATOR

Ultrasound guided retroclavicular block

Intervention Type OTHER

Ultrasound guided retroclavicular block for forearm or hand surgery

Ultrasound guided coracoid infraclavicular block

Intervention Type OTHER

Ultrasound guided infraclavicular block for forearm or hand surgery

Bupivacaine

Intervention Type DRUG

Ultrasound

Intervention Type DEVICE

Interventions

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Ultrasound guided retroclavicular block

Ultrasound guided retroclavicular block for forearm or hand surgery

Intervention Type OTHER

Ultrasound guided coracoid infraclavicular block

Ultrasound guided infraclavicular block for forearm or hand surgery

Intervention Type OTHER

Bupivacaine

Intervention Type DRUG

Ultrasound

Intervention Type DEVICE

Other Intervention Names

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Group R Group C

Eligibility Criteria

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Inclusion Criteria

* 18-80 years
* BMI\>30
* Forearm- Hand surgery

Exclusion Criteria

* \<18 years
* Local infection
* Coagulopaty
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Kahramanmaras Sutcu Imam University

OTHER

Sponsor Role lead

Responsible Party

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Bora Bilal

Assistant Proffesor

Responsibility Role PRINCIPAL_INVESTIGATOR

Other Identifiers

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31

Identifier Type: -

Identifier Source: org_study_id