Nerve Stimulator Versus Ultrasound-guided Infraclavicular Block

Overview

The investigators compared the postoperative analgesia of nerve stimulator-guided and ultrasound-guided infraclavicular block for upper extremity surgery.

Full Title of Study: “A Randomized Comparison of Nerve Stimulator and Ultrasound-guided Infraclavicular Block for Upper Extremity Surgery”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Triple (Participant, Care Provider, Outcomes Assessor)
  • Study Primary Completion Date: December 2015

Detailed Description

Ultrasound (US)-guided peripheral nerve block has increased in popularity. It has many advantages such as improved success rate, faster onset time, fewer needle passes, shorter performance time, and reduced procedural pain and vascular puncture. However, there is no information about postoperative analgesia. Therefore, the investigators tested whether ultrasound-guided peripheral nerve block enhanced the postoperative analgesia for upper extremity surgery compared with nerve stimulator (NS) guidance.

Interventions

  • Procedure: NS-guided infraclavicular block
    • Patients received a standard single injection infraclavicular block using the lateral sagittal approach of Klaastad. The infraclavicular brachial plexus is identified using an insulated needle connected to a nerve stimulator. Placement of the needle is considered adequate if motor response of radial nerve in the hand or wrist is still present at 0.2 – 0.5mA. Ropivacaine 0.5% 35ml is used.
  • Procedure: US-guided infraclavicular block
    • Infraclavicular block is performed under ultrasound guidance. Linear probe is placed in a parasagittal positon below the clavicle medial to the coracoid process and adjusted to achieve a cross-sectional image of the axillary artery. Using in-plane technique, an 22-gauge insulated needle is advanced caudally and posteriorly to the axillary artery. Subsequently, 35 ml of 0.5% ropivacaine is incrementally injected.

Arms, Groups and Cohorts

  • Active Comparator: NS-guided infraclavicular block
    • NS-guided infraclavicular block is performed using 35 ml of 0.5% ropivacaine.
  • Experimental: US-guided infraclavicular block
    • US-guided infraclavicular block is performed using 35 ml of 0.5% ropivacaine.

Clinical Trial Outcome Measures

Primary Measures

  • Duration of postoperative analgesia
    • Time Frame: at 24h after surgery
    • time from completion of local anesthetic injection until the first request for an analgesic

Secondary Measures

  • block performance time
    • Time Frame: at 30 min after block placement
    • the time between the block needle insertion and needle withdrawal
  • number of needle redirections
    • Time Frame: at 30 min after block placement
    • either forward or backward movement of needle at least 1 cm or more
  • patient discomfort
    • Time Frame: at 30 min after block placement
    • pain score (0-10) during the procedure
  • paresthesia
    • Time Frame: at 30 min after block placement
    • presence of paresthesia during the procedure
  • onset time
    • Time Frame: until 30min after completion of local anesthetic
    • complete block of sensory nerve (radial, ulnar, median, musculocutaneous, and medial antebrachial cutaneous nerve)
  • motor block of hand
    • Time Frame: at 24h after surgery
    • presence of motor block in the operated hand
  • postoperative dysesthesia
    • Time Frame: at 24h after surgery
    • presence of any paresthesia in the operated extremity
  • supplemental analgesia
    • Time Frame: at 24h after surgery
    • Rescue analgesia with 75 mg of IM diclofenac was available on demand.
  • Pain score
    • Time Frame: at 24h after surgery
  • Patient satisfaction
    • Time Frame: at 24h after surgery
    • The acceptance of the anesthetic technique was evaluated using a two-point score: 1, satisfactory (if necessary, I would have the same anesthetic technique); and 2, unsatisfactory (different anesthetic technique).

Participating in This Clinical Trial

Inclusion Criteria

  • American Society of Anesthesiologists physical class I – III patients scheduled to undergo upper extremity surgery Exclusion Criteria:

  • coagulopathy, severe pulmonary disease, neuropathy, contralateral diaphragmatic paresis, allergy to study medications

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 80 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Cheju Halla General Hospital
  • Provider of Information About this Clinical Study
    • Principal Investigator: Chunwoo Yang, Department of Anesthesiology and pain medicine – Cheju Halla General Hospital
  • Overall Official(s)
    • Chunwoo Yang, MD, Principal Investigator, Dept. of anesthesia and pain medicine, Cheju Halla General Hospital

References

Choi S, McCartney CJ. Evidence Base for the Use of Ultrasound for Upper Extremity Blocks: 2014 Update. Reg Anesth Pain Med. 2016 Mar-Apr;41(2):242-50. doi: 10.1097/AAP.0000000000000155.

Koscielniak-Nielsen ZJ. Ultrasound-guided peripheral nerve blocks: what are the benefits? Acta Anaesthesiol Scand. 2008 Jul;52(6):727-37. doi: 10.1111/j.1399-6576.2008.01666.x. Epub 2008 May 12.

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