Description of the Brachial Plexus Block at the Humeral Head in Children: a Sono-anatomical Study

NCT ID: NCT06158243

Last Updated: 2023-12-06

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

NOT_YET_RECRUITING

Total Enrollment

50 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-12-31

Study Completion Date

2024-04-30

Brief Summary

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the investigators are interested in assessing the feasibility and value of brachial plexus block at the level of the humeral head in children. As a first step, the investigators propose to carry out a sono-anatomical study to describe the plexus at this level, the distribution of nerves in relation to the axillary artery, and the description of bone and muscle structures.

Detailed Description

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Brachial plexus blocks below the clavicle provide anesthesia and analgesia of the upper limb for elbow, forearm and hand surgery. Among the techniques described, axillary and costo-clavicular blocks are most frequently used.

In the axillary approach to the brachial plexus, the ulnar, median and radial nerves are in the direct vicinity of the axillary artery. However, there is considerable variability in the location of these nerves . What's more, the musculocutaneous nerve is most often distant from the other nerves of the plexus. These disadvantages are not encountered with the costo-clavicular technique, in which the nerves are brought together in the same diffusion space. On the other hand, this method does run the risk of pneumothorax and anesthesia of the phrenic nerve.

In this context, the investigators have described the brachial plexus block at the level of the humeral head in adults, which enables practicians to work on nerves gathered around the axillary artery without any risk of phrenic or pulmonary damage4.

In children, Small et al described a supra-clavicular approach, but Clayton et al, noting the high risk of pneumothorax, strongly advocated the axillary approach.

Conditions

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Anesthesia, Local Brachial Plexus; Pressure

Keywords

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Brachial plexus

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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0-2

children aged 0 to 2 years

Sono-anatomical Study

Intervention Type OTHER

The arm is abducted (90°), externally rotated, with the forearm flexed over the arm (90°). A linear ultrasound probe (8-15 MHz) is placed in front of the humeral head, in a sagittal plane. Location begins at axillary level, vessels, nerves and humerus are identified, and the probe is moved medially to reach and identify the humeral head.

2-4

children aged 2 to 4 years

No interventions assigned to this group

4-6

children aged 4 to 6 years

No interventions assigned to this group

6-8

children aged 6 to 8 years

Sono-anatomical Study

Intervention Type OTHER

The arm is abducted (90°), externally rotated, with the forearm flexed over the arm (90°). A linear ultrasound probe (8-15 MHz) is placed in front of the humeral head, in a sagittal plane. Location begins at axillary level, vessels, nerves and humerus are identified, and the probe is moved medially to reach and identify the humeral head.

8-10

children aged 8 to 10 years

No interventions assigned to this group

Interventions

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Sono-anatomical Study

The arm is abducted (90°), externally rotated, with the forearm flexed over the arm (90°). A linear ultrasound probe (8-15 MHz) is placed in front of the humeral head, in a sagittal plane. Location begins at axillary level, vessels, nerves and humerus are identified, and the probe is moved medially to reach and identify the humeral head.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* patient ASA 1-2
* aged 0 to 10 years
* scheduled surgery
* parental consent obtained

Exclusion Criteria

* Parental refusal to participate
* suspicion of local skin infection
* inability to place the limb in the position required for sonographic examination
* Upper limb malformation
* ASA III, IV
* Major surgery (cardiac, neurosurgery...)
* emergencies
Minimum Eligible Age

1 Month

Maximum Eligible Age

10 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Centre Hospitalier Universitaire Saint Pierre

OTHER

Sponsor Role lead

Responsible Party

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Raoul Ngatcha

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Emmanuel GUNTZ

Role: STUDY_DIRECTOR

Anesthesiologist

Central Contacts

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Raoul Ngatcha

Role: CONTACT

Phone: +32493869805

Email: [email protected]

References

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Nalini KB, Bevinaguddaiah Y, Thiyagarajan B, Shivasankar A, Pujari VS. Ultrasound-guided costoclavicular vs. axillary brachial plexus block: A randomized clinical study. J Anaesthesiol Clin Pharmacol. 2021 Oct-Dec;37(4):655-660. doi: 10.4103/joacp.JOACP_43_20. Epub 2021 Nov 2.

Reference Type BACKGROUND
PMID: 35340944 (View on PubMed)

Christophe JL, Berthier F, Boillot A, Tatu L, Viennet A, Boichut N, Samain E. Assessment of topographic brachial plexus nerves variations at the axilla using ultrasonography. Br J Anaesth. 2009 Oct;103(4):606-12. doi: 10.1093/bja/aep207. Epub 2009 Aug 21.

Reference Type BACKGROUND
PMID: 19700445 (View on PubMed)

SMALL GA. Brachial plexus block anesthesia in children. J Am Med Assoc. 1951 Dec 22;147(17):1648-51. doi: 10.1001/jama.1951.03670340038009. No abstract available.

Reference Type BACKGROUND
PMID: 14880419 (View on PubMed)

Li JW, Songthamwat B, Samy W, Sala-Blanch X, Karmakar MK. Ultrasound-Guided Costoclavicular Brachial Plexus Block: Sonoanatomy, Technique, and Block Dynamics. Reg Anesth Pain Med. 2017 Mar/Apr;42(2):233-240. doi: 10.1097/AAP.0000000000000566.

Reference Type BACKGROUND
PMID: 28157792 (View on PubMed)

Related Links

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https://rapm.bmj.com/content/47/Suppl_1/A126.1

this work is the first we have done in adults " brachial intermediate nerve block"

Other Identifiers

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B062023230501

Identifier Type: -

Identifier Source: org_study_id