Axillary Block in Association With Analgesic Truncal Blocks at the Elbow for Wrist Surgery.

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

NA

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-10-07

Study Completion Date

2022-09-15

Brief Summary

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Fractures of the forearm bones that occur around the wrist are common in the elderly. Standard anesthesia for its surgical treatment is regional anesthesia (RA): supraclavicular block, infraclavicular block or axillary block (BAX). However, these techniques have some limitations, such as the postoperative pain management and the non-specificity of the analgesia. Indeed analgesia is not specific to the wrist and extends to the elbow and forearm, preventing rapid recovery of elbow flexion and extension when a long-acting local anesthetic (LA) is used. Recently RA techniques associating proximal anesthetic blocks with distal analgesic blocks have been proposed to serve a dual objective: good anesthesia for surgery and specific analgesia.

The hypothesis of this study is that, for the wrist surgery, axillary block using a short-acting LA combined with analgesic blocks at the elbow using a long-acting LA could provide a RA installation time reduction, an optimal surgical comfort, a longer post-operative analgesia duration and a faster recovery from motor block.

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Detailed Description

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This multicenter, prospective, randomized, open-Label study compares two techniques :

* BAX (usual technique) : Axillary brachial plexus block (Axillary block) with a long-acting LA (Ropivacaine)
* BAX-Asso (experimental technique) : Axillary brachial plexus block (Axillary block) with a short-acting local anesthetic (Lidocaine) + Analgesic block at the elbow with a long-acting local anesthetic (Ropivacaine) Every block will be performed under Ultrasound. BAX will be performed using a multi-injection technique at contact with median (nM), radial (nR), ulnar (nU), musculocutaneous (nMC) and medial antebrachial cutaneous (nCMAB) nerves. 15-30 mL of LA will be injected.

Analgesic truncal blocks of the median and radial nerves will be performed at the elbow. 3-7 mL of LA will be injected.

Conditions

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Wrist Fracture

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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BAX

Group Type ACTIVE_COMPARATOR

Axillary brachial plexus block with a long-acting local anesthetic

Intervention Type PROCEDURE

axillary block with 15-30 ml Ropivacaine 0,5%.

Ropivacaine

Intervention Type DRUG

axillary block with 15-30 ml Ropivacaine 0,5%

BAX-Asso

Group Type EXPERIMENTAL

Axillary brachial plexus block with a short-acting local anesthetic + Analgesic block at the elbow with a long-acting local anesthetic

Intervention Type PROCEDURE

axillary block with 15-30 ml Lidocaine 1,5% + radial and medial nerve block at the elbow with 3-7 ml Ropivacaine 0,5%.

Ropivacaine

Intervention Type DRUG

radial and medial nerve block at the elbow with 3-7 ml Ropivacaine 0,5%

Lidocaine

Intervention Type DRUG

axillary block with 15-30 ml Lidocaine 1,5%

Interventions

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Axillary brachial plexus block with a long-acting local anesthetic

axillary block with 15-30 ml Ropivacaine 0,5%.

Intervention Type PROCEDURE

Axillary brachial plexus block with a short-acting local anesthetic + Analgesic block at the elbow with a long-acting local anesthetic

axillary block with 15-30 ml Lidocaine 1,5% + radial and medial nerve block at the elbow with 3-7 ml Ropivacaine 0,5%.

Intervention Type PROCEDURE

Ropivacaine

axillary block with 15-30 ml Ropivacaine 0,5%

Intervention Type DRUG

Ropivacaine

radial and medial nerve block at the elbow with 3-7 ml Ropivacaine 0,5%

Intervention Type DRUG

Lidocaine

axillary block with 15-30 ml Lidocaine 1,5%

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients undergoing wrist fracture surgery under regional anesthesia
* Consent for participation
* Affiliation to the French social security system

Exclusion Criteria

* Chronic use of opiod analgesics
* Chronic pain syndrome or fibromyalgia
* Contraindication for locoregional anesthesia
* Contraindication for opioid
* ASA IV
* Pregnant or breastfeeding women
* Patients under protection of the adults (guardianship, curators or safeguard of justice)
* Communication difficulties or neuropsychiatric disorder

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No