Lateral Sagittal vs Costoclavicular Approach for Ultrasound-Guided Infraclavicular Block

NCT ID: NCT04356521

Last Updated: 2020-10-26

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

109 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-05-01

Study Completion Date

2020-10-20

Brief Summary

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An ultrasound-guided infraclavicular block performed with the costoclavicular (CC) approach and the lateral sagittal (LS) approach will be compared in patients scheduled for forearm and hand surgery.

Detailed Description

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The CC approach is a recently introduced infraclavicular approach that targets three cords (medial, lateral and posterior) located lateral to the axillary artery in the costoclavicular space. Cords in this space are located more superficially than with the classical approach at the lateral infraclavicular fossa and are clustered but maintain a consistent anatomical relationship with each other.

Patients will be divided into two groups:

Group LS: Ultrasound-guided infraclavicular block - lateral sagittal approach (20 ml 0.5% bupivacaine)

Group CC: Ultrasound-guided infraclavicular block - costoclavicular approach (20 ml 0.5% bupivacaine)

Conditions

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Anesthesia, Local Nerve Block Brachial Plexus Block

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Group LS

Ultrasound-guided infraclavicular block - lateral sagittal approach (20 ml 0.5% bupivacaine)

Group Type ACTIVE_COMPARATOR

Lateral Sagittal Approach

Intervention Type PROCEDURE

The US probe will be located medial to the coracoid process in the sagittal plane in the infraclavicular region, and then three cords of the brachial plexus will be viewed. Using the in-plane technique, bupivacaine 0.5% will be administered around the posterior cord (7ml), lateral cord (7ml), and medial cord (6ml).

Group CC

Ultrasound-guided infraclavicular block - costoclavicular approach (20 ml 0.5% bupivacaine)

Group Type ACTIVE_COMPARATOR

Costoclavicular Approach

Intervention Type PROCEDURE

The US probe will be placed parallel to the clavicle in the midclavicular area and tilted toward the cephalad and the axillary artery, and three cords will be viewed. A needle will be forwarded from lateral to medial with the in-plane technique, and 20 ml of bupivacaine 0.5% will be administered at the center of the three cords.

Interventions

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Lateral Sagittal Approach

The US probe will be located medial to the coracoid process in the sagittal plane in the infraclavicular region, and then three cords of the brachial plexus will be viewed. Using the in-plane technique, bupivacaine 0.5% will be administered around the posterior cord (7ml), lateral cord (7ml), and medial cord (6ml).

Intervention Type PROCEDURE

Costoclavicular Approach

The US probe will be placed parallel to the clavicle in the midclavicular area and tilted toward the cephalad and the axillary artery, and three cords will be viewed. A needle will be forwarded from lateral to medial with the in-plane technique, and 20 ml of bupivacaine 0.5% will be administered at the center of the three cords.

Intervention Type PROCEDURE

Other Intervention Names

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Infraclavicular Block - Lateral Sagittal Approach Infraclavicular Block - Costoclavicular Approach

Eligibility Criteria

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Inclusion Criteria

* Age 18 years to 65 years
* Patients scheduled for elective forearm and hand surgeries
* Patients with American Society of Anesthesiologists (ASA) 1-3

Exclusion Criteria

* Patients not consenting/unwilling to participate
* Age \<18 years or \>65 years
* Patients with ASA 4
* Obesity (BMI \>30 kg/m2)
* Regional anesthesia contraindicated (thrombocytopenia, infection at injection site)
* Severe renal, cardiac, or hepatic disease
* History of hypersensitivity or allergy to local anesthetics
* History of opioid or steroid use for more than 4 weeks
* History of psychiatric disorders
* Analgesic treatment in the last 48 hours preoperatively
* Operations lasting less than 60 minutes and more than 180 minutes
* Patients who converted to general anesthesia
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Ondokuz Mayıs University

OTHER

Sponsor Role lead

Responsible Party

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BURHAN DOST

Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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BURHAN DOST

Role: PRINCIPAL_INVESTIGATOR

Ondokuz Mayıs University

Locations

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Ondokuz Mayis University

Samsun, Atakum, Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

References

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Leurcharusmee P, Elgueta MF, Tiyaprasertkul W, Sotthisopha T, Samerchua A, Gordon A, Aliste J, Finlayson RJ, Tran DQH. A randomized comparison between costoclavicular and paracoracoid ultrasound-guided infraclavicular block for upper limb surgery. Can J Anaesth. 2017 Jun;64(6):617-625. doi: 10.1007/s12630-017-0842-z. Epub 2017 Feb 15.

Reference Type BACKGROUND
PMID: 28205117 (View on PubMed)

Songthamwat B, Karmakar MK, Li JW, Samy W, Mok LYH. Ultrasound-Guided Infraclavicular Brachial Plexus Block: Prospective Randomized Comparison of the Lateral Sagittal and Costoclavicular Approach. Reg Anesth Pain Med. 2018 Nov;43(8):825-831. doi: 10.1097/AAP.0000000000000822.

Reference Type BACKGROUND
PMID: 29923950 (View on PubMed)

Kavrut Ozturk N, Kavakli AS. Comparison of the coracoid and retroclavicular approaches for ultrasound-guided infraclavicular brachial plexus block. J Anesth. 2017 Aug;31(4):572-578. doi: 10.1007/s00540-017-2359-6. Epub 2017 Apr 18.

Reference Type BACKGROUND
PMID: 28421316 (View on PubMed)

Oh C, Noh C, Eom H, Lee S, Park S, Lee S, Shin YS, Ko Y, Chung W, Hong B. Costoclavicular brachial plexus block reduces hemidiaphragmatic paralysis more than supraclavicular brachial plexus block: retrospective, propensity score matched cohort study. Korean J Pain. 2020 Apr 1;33(2):144-152. doi: 10.3344/kjp.2020.33.2.144.

Reference Type BACKGROUND
PMID: 32235015 (View on PubMed)

Layera S, Aliste J, Bravo D, Fernandez D, Garcia A, Finlayson RJ, Tran DQ. Single- versus double-injection costoclavicular block: a randomized comparison. Reg Anesth Pain Med. 2020 Mar;45(3):209-213. doi: 10.1136/rapm-2019-101167. Epub 2020 Jan 14.

Reference Type BACKGROUND
PMID: 31941792 (View on PubMed)

Mistry T, Balavenkatasubhramanian J, Natarajan V, Kuppusamy E. Ultrasound-guided bilateral costoclavicular brachial plexus blocks for single-stage bilateral upper limb surgeries: Abstain or indulge. J Anaesthesiol Clin Pharmacol. 2019 Oct-Dec;35(4):556-557. doi: 10.4103/joacp.JOACP_222_18. No abstract available.

Reference Type BACKGROUND
PMID: 31920246 (View on PubMed)

Monzo E, Hadzic A. Costoclavicular approach to the brachial plexus block: simple or double injection? Reg Anesth Pain Med. 2019 Sep 29:rapm-2019-100852. doi: 10.1136/rapm-2019-100852. Online ahead of print. No abstract available.

Reference Type BACKGROUND
PMID: 31570494 (View on PubMed)

Silva GR, Borges DG, Lopes IF, Ruzi RA, Costa PRRM, Mandim BLDS. [Ultrasound-guided costoclavicular block as an alternative for upper limb anesthesia in obese patients]. Braz J Anesthesiol. 2019 Sep-Oct;69(5):510-513. doi: 10.1016/j.bjan.2019.01.004. Epub 2019 Sep 10.

Reference Type BACKGROUND
PMID: 31519300 (View on PubMed)

Other Identifiers

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CC0255

Identifier Type: -

Identifier Source: org_study_id