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
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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NOT_YET_RECRUITING
50 participants
OBSERVATIONAL
2023-12-31
2024-04-30
Brief Summary
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Detailed Description
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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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Keywords
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Study Design
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COHORT
PROSPECTIVE
Study Groups
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0-2
children aged 0 to 2 years
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.
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
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.
Eligibility Criteria
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Inclusion Criteria
* aged 0 to 10 years
* scheduled surgery
* parental consent obtained
Exclusion Criteria
* 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
1 Month
10 Years
ALL
Yes
Sponsors
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Centre Hospitalier Universitaire Saint Pierre
OTHER
Responsible Party
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Raoul Ngatcha
MD
Principal Investigators
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Emmanuel GUNTZ
Role: STUDY_DIRECTOR
Anesthesiologist
Central Contacts
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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.
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.
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.
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.
Related Links
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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