Changes in Vessels After Peripheral Block

NCT ID: NCT05968105

Last Updated: 2023-12-08

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

Total Enrollment

60 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-08-02

Study Completion Date

2023-12-03

Brief Summary

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In patients with fluid deficit, vasoconstriction occurs in peripheral tissues and blood circulation is kept in the central area. It causes arterial vasodilation and hemodynamic variability by increasing the blood volume of the extremity due to the sympathectomy occurring after the block. When the investigators classify patients according to VCI-CI, it will be questioned whether there is a difference between patients' block quality and hemodynamic variability.

Detailed Description

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VCI-CI helps us to have an idea about the amount of fluid in patients according to the vena cava Inferior (VCI) diameter and the diameter between the inspiring and expiration. Low arterial diameter and high inspiratory and expiratory variability indicate that the patient's fluid volume may be lower.

In the measurement of VCI diameter, VCI has visualized in the craniocaudal plane thanks to the transverse ultrasound probe. Changes in VCI diameter are observed depending on the negative pressure in the thoracic area during inspiration and expiration. When the difference between this rate of change is greater than 50%, it indicates that the patient has a fluid deficit. The fact that the VCI diameter is also below 1.5 cm indicates that this amount of fluid requirement is more serious. In this study, the investigators will question whether there is a difference between patients' block quality and hemodynamic variability when they classify patients according to VCI-CI.

Conditions

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Anesthesia, Local Vena Cava Syndrome (Inferior) (Superior) Fluid Loss Postoperative Pain

Keywords

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Vena Cava Inferior Collapsibility Index Lateral Sagittal Infraclavicular Block VCI-CI

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Group 1

Inferior vena cava diameter \<1.5 cm and VCI-CI \> 50% according to Vena Cava Inferior Collapsibility Index (VCI-CI)

Lateral Sagittal Infraclavicular Block

Intervention Type PROCEDURE

Patients will be in the supine position and after aseptic conditions are provided, the axillary artery of the patient will be visualized in the craniocaudal plane, in the infraclavicular region and in the lateral sagittal position with the help of an 8-12 mHz linear probe. After the brachial plexus cords around the axillary artery are identified, a local anesthetic mixture will be applied in-plane between the posterior cord and the artery. During the block, patients will routinely be given a mixture of 0.25% bupivacaine + 0.5% lidocaine 0.5 mL/kg.

Inferior vena cava diameter <1.5 cm and Vena Cava Inferior Collapsibility Index (VCI-CI) > 50%

Intervention Type DIAGNOSTIC_TEST

While the patients are lying in the supine position, the vena cava will be determined 2 cm before the inferior heart entrance with the help of a 3.5-5 mHz convex probe. M-mode ECHO will be used to determine the fluctuation rate of the VCI between inspiration and expiration. After determining the farthest and closest points in M-mode ECO, their ratios to each other will be calculated.

Group 2

Inferior vena cava diameter \>1.5 cm and VCI-CI \< 50% according to Vena Cava Inferior Collapsibility Index (VCI-CI)

Lateral Sagittal Infraclavicular Block

Intervention Type PROCEDURE

Patients will be in the supine position and after aseptic conditions are provided, the axillary artery of the patient will be visualized in the craniocaudal plane, in the infraclavicular region and in the lateral sagittal position with the help of an 8-12 mHz linear probe. After the brachial plexus cords around the axillary artery are identified, a local anesthetic mixture will be applied in-plane between the posterior cord and the artery. During the block, patients will routinely be given a mixture of 0.25% bupivacaine + 0.5% lidocaine 0.5 mL/kg.

Inferior vena cava diameter >1.5 cm and Vena Cava Inferior Collapsibility Index (VCI-CI) < 50%

Intervention Type PROCEDURE

While the patients are lying in the supine position, the vena cava will be determined 2 cm before the inferior heart entrance with the help of a 3.5-5 mHz convex probe. M-mode ECHO will be used to determine the fluctuation rate of the VCI between inspiration and expiration. After determining the farthest and closest points in M-mode ECO, their ratios to each other will be calculated.

Interventions

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Lateral Sagittal Infraclavicular Block

Patients will be in the supine position and after aseptic conditions are provided, the axillary artery of the patient will be visualized in the craniocaudal plane, in the infraclavicular region and in the lateral sagittal position with the help of an 8-12 mHz linear probe. After the brachial plexus cords around the axillary artery are identified, a local anesthetic mixture will be applied in-plane between the posterior cord and the artery. During the block, patients will routinely be given a mixture of 0.25% bupivacaine + 0.5% lidocaine 0.5 mL/kg.

Intervention Type PROCEDURE

Inferior vena cava diameter >1.5 cm and Vena Cava Inferior Collapsibility Index (VCI-CI) < 50%

While the patients are lying in the supine position, the vena cava will be determined 2 cm before the inferior heart entrance with the help of a 3.5-5 mHz convex probe. M-mode ECHO will be used to determine the fluctuation rate of the VCI between inspiration and expiration. After determining the farthest and closest points in M-mode ECO, their ratios to each other will be calculated.

Intervention Type PROCEDURE

Inferior vena cava diameter <1.5 cm and Vena Cava Inferior Collapsibility Index (VCI-CI) > 50%

While the patients are lying in the supine position, the vena cava will be determined 2 cm before the inferior heart entrance with the help of a 3.5-5 mHz convex probe. M-mode ECHO will be used to determine the fluctuation rate of the VCI between inspiration and expiration. After determining the farthest and closest points in M-mode ECO, their ratios to each other will be calculated.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Hand and Wrist elective surgery
* Infraclavicular block will be applied
* American Society of Anesthesiologists (ASA) physical condition I-II
* Patients aged 18-65 years

Exclusion Criteria

* Contraindication for central or peripheral blocks
* Cognitive dysfunction
* History of chronic opioid use
* severe organ dysfunction
* Allergy to any drug used in the study
* Body mass index (BMI) ≥30
* Infection in the area to be treated
* Refusal to participate in the research
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Başakşehir Çam & Sakura City Hospital

OTHER_GOV

Sponsor Role lead

Responsible Party

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Ergün Mendeş

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ergun Mendes

Role: PRINCIPAL_INVESTIGATOR

Başakşehir Çam & Sakura City Hospital

Locations

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Ergun Mendes

Küçükçekmece, İ̇stanbul, Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

References

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Zhang H, Yuan H, Yu H, Zhang Y, Feng S. Correlation between pleth variability index and ultrasonic inferior vena cava-collapsibility index in parturients with twin pregnancies undergoing cesarean section under spinal anesthesia. Eur J Med Res. 2022 Aug 6;27(1):139. doi: 10.1186/s40001-022-00771-3.

Reference Type BACKGROUND
PMID: 35933431 (View on PubMed)

Other Identifiers

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KAEK/2023.06.260

Identifier Type: OTHER

Identifier Source: secondary_id

e.mendes - 3

Identifier Type: -

Identifier Source: org_study_id