Retroclavicular Versus Supraclavicular Brachial Plexus Block for Hand and Forearm Surgery

Overview

Patients will be randomized to one of two groups: 1. Supraclavicular group: supraclavicular brachial plexus block performed with the aid of ultrasound; 2. Retroclavicular group: retroclavicular brachial plexus block performed with the aid of ultrasound.

Full Title of Study: “The Efficacy of Retroclavicular Versus Supraclavicular Brachial Plexus Block in Patients Undergoing Forearm and Hand Surgery: a Randomized Controlled Double-blinded Trial.”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Double (Participant, Outcomes Assessor)
  • Study Primary Completion Date: May 2018

Detailed Description

The study will be proposed to all patients undergoing formarm or hand surgery under brachial plexus block. Patients will be randomized to one of two groups The first group - supraclavicular group – will receive an ultrasound-guided brachial plexus block via the supraclavicular approach, by injection of 30 ml of a mixture of ropivacaine 0.5 % + mepivacaine 1 %. The second group – retroclavicular group – will receive an ultrasound-guided brachial plexus block via the retroclavicular approach, by injection of 30 ml of a mixture of ropivacaine 0.5 % + mepivacaine 1 %. Primary outcome is success rate at 30 minutes after the injection defined as loss of sensation to pinprick in the forearm and hand. Secondary outcomes are: needling time, time to first analgesic request, postoperative opioid consumption, pain scores at 12 and 24 hours postoperatively, block-related complications, and patient satisfaction.

Interventions

  • Procedure: retroclavicular block
    • retroclavicular block for forearm or hand surgery
  • Procedure: supraclavicular block
    • supraclavicular block for forearm or hand surgery

Arms, Groups and Cohorts

  • Active Comparator: supraclavicular
    • patients receive a supraclavicular block for forearm or hand surgery with 30 ml of a mixture of ropivacaine 0.5 % and mepivacaine 1 %
  • Experimental: retroclavicular block
    • patients receive a retroclavicular block for forearm or hand surgery with 30 ml of a mixture of ropivacaine 0.5 % and mepivacaine 1 %

Clinical Trial Outcome Measures

Primary Measures

  • Success rate (loss of sensation to pinprick in the forearm and hand)
    • Time Frame: 30 minutes after the injection

Secondary Measures

  • Needling time in seconds
    • Time Frame: 15 min
  • Time to first analgesic request
    • Time Frame: 24 hours
  • Block-related complications
    • Time Frame: 24 hours
  • Postoperative opioid consumption on postoperative day 1
    • Time Frame: 24 hours
  • Pain scores at 12 hours postoperatively
    • Time Frame: 12 hours
    • measured on a visual analogue scale between 0 and 100
  • Pain scores on postoperative day 1
    • Time Frame: 24 hours
    • measured on a visual analogue scale between 0 and 100
  • Patient satisfaction as assessed by numerical rating scale
    • Time Frame: 24 hours
    • Patient satisfaction on a scale between 0 (= completely dissatisfied) and 10 (= completely satisfied)

Participating in This Clinical Trial

Inclusion Criteria

  • Adult patients who undergo forearm or hand surgery under brachial plexus block. Exclusion Criteria:

  • History of allergic reaction to local anaesthetics – Peripheral neuropathy – Renal or hepatic insufficiency – Coagulation disorders

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Hôpital du Valais
  • Provider of Information About this Clinical Study
    • Principal Investigator: Sina Grape, MD – Hôpital du Valais
  • Overall Official(s)
    • Sina Grape, MD, Principal Investigator, Hopital du Valais
    • Eric Albrecht, MD, Study Director, CHUV

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