Supraclavicular Brachial Plexus Block During Upper Limb Surgeries
NCT ID: NCT05315271
Last Updated: 2023-02-03
Study Results
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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COMPLETED
EARLY_PHASE1
60 participants
INTERVENTIONAL
2022-06-01
2023-01-20
Brief Summary
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They provide perfect pain control, decreased complications and reduced post-anesthesia care unit stay.
Regional anesthesia provides more patient safety and better outcomes, which leads to the fact that ultrasound-guided regional anesthesia became more popular.
Ultrasound provides clinicians with real-time images which are useful for better identification of the anatomical structures, safe needle placement and adequate local anesthetic spread.
Brachial plexus blocks are commonly achieved via an interscalene, supraclavicular, infraclavicular or axillary approach.
The supraclavicular level is an ideal site to achieve anesthesia of the entire upper extremity just distal to the shoulder as the plexus remains relatively tightly packed at this level, resulting in a rapid and high-quality block. For this reason, the supraclavicular block is often called the ''spinal of the arm'' Using the local anesthetics alone for supraclavicular brachial plexus block provide good operative conditions but have the disadvantage of shorter duration of postoperative analgesia. Various adjuvants such as opioids, dexmedetomidine, dexamethasone, midazolam, ketamine, etc., were added to local anesthetics in brachial plexus block to achieve quick and prolonged block.
Ketamine is a noncompetitive antagonist of the N-methyl-D aspartate receptor(NMDAR).
It is used as a premedication, and for sedation, induction and maintenance of general anesthesia.
Local anesthetic and analgesic properties have been reported for ketamine. Intravenous administration of low-dose ketamine decreases postoperative opioid use and improves analgesia.
Ketamine has been added to bupivacaine to prolong the duration of regional anesthesia and postoperative analgesia.
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Detailed Description
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Conditions
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Study Design
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RANDOMIZED
PARALLEL
SCREENING
NONE
Study Groups
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Group 1
All patients will be randomly allocated into two equal groups: each group will contain 30patients:
Bupivacaine-ketamine injection
20 ml volume bupivacaine only (0.5%concentration) (with maximum dose not exceeding 4mg/kg ) plus ketamine (1 mg/kg) with maximum dose 100mg ; the total volume is 30 ml with the infusion of 100 ml normal saline at a rate of 100ml/h.
Group 2
All patients will be randomly allocated into two equal groups: each group will contain 30patients:
Bupivacaine injection with intravenous ketamine infusion
20 ml volume bupivacaine only (0.5%concentration) (with maximum dose not exceeding 4mg/kg ) plus 10 ml saline ; the total volume is 30 ml with the infusion of ketamine 0.15 mg/kg added to 100 ml normal saline and will be infused at a rate of 100 ml/h, which will be stopped 5 min before the end of surgery.
Interventions
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Bupivacaine-ketamine injection
20 ml volume bupivacaine only (0.5%concentration) (with maximum dose not exceeding 4mg/kg ) plus ketamine (1 mg/kg) with maximum dose 100mg ; the total volume is 30 ml with the infusion of 100 ml normal saline at a rate of 100ml/h.
Bupivacaine injection with intravenous ketamine infusion
20 ml volume bupivacaine only (0.5%concentration) (with maximum dose not exceeding 4mg/kg ) plus 10 ml saline ; the total volume is 30 ml with the infusion of ketamine 0.15 mg/kg added to 100 ml normal saline and will be infused at a rate of 100 ml/h, which will be stopped 5 min before the end of surgery.
Eligibility Criteria
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Inclusion Criteria
* ASA physical status I-II, scheduled.
* Patients of either sex.
* Unilateral elective upper limb surgeries undergoing under ultrasound guided supraclavicular brachial plexus block.
Exclusion Criteria
* Patients with peripheral neuropathy of the upper limb.
* Infection at the injection site.
* Uncontrolled diabetes, epilepsy, obstructive pulmonary disease and neuromuscular disease.
* Altered mental status.
* Hypersensitivity to bupivacaine and ketamine.
* Patients with coagulopathy.
18 Years
75 Years
ALL
Yes
Sponsors
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Sohag University
OTHER
Responsible Party
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Ahmed Gamal Abdelah
Resident of Anesthesiology , Intensive care unit and Pain management.
Locations
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Sohag University
Sohag, , Egypt
Countries
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References
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1. Abdallah F, Brull R Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth 110(6):915-925,2013. 2. Hanumanthaiah D, Vaidiyanathan S, Garstka M, Szucs S, Iohom G Ultrasound guided supraclavicular block. Med Ultrason 15(3):224-229,2013. 3. Argiriadou KS, McEwen A, Matthew G: Ultrasound-Guided Supraclavicular Brachial Plexus Block https: //www.wfsahq.org/components/com_virtual_library/media/2ffc0a053d75e1cae94f9 3f57cddb8ff-atow-384-00-01.pdf,2018. 4. Swami SS, Keniya VM, Ladi SD, et al. Comparison of dexmedetomidine and clonidine (α2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block: a randomised double-blind prospective study. Indian J Anaesth; 56:243-249,2012. 5. Kohli S, Kaur M, Sahoo S, et al. Brachial plexus block: comparison of two different doses of clonidine added to bupivacaine. J Anaesthesiol Clin Pharmacol; 29:491-495, 2013. 6. Reves JG, Glass PS, Lubarsky DA, et al. Intravenous anesthetic. In: Miller R, editor. Miller's anesthesia. 7th ed. Philadelphia: Churchill Livingstone; 724-726, 2010.
Other Identifiers
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soh-Med-21-10-07
Identifier Type: -
Identifier Source: org_study_id
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