Comparison of Supraclavicular and Costoclavicular Brachial Plexus Blocks in Pediatrics
Condition: Anesthesia, Local; Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      In upper extremity surgeries, the brachial plexus block can be performed with different
      techniques at various levels depending on the proximal and distal level of the surgery.

      As an alternative to the infraclavicular brachial plexus block, which has been used for many
      years and which we routinely perform to every pediatric patient under general anesthesia;
      Costoclavicular block is recommended due to its advantages such as short application time,
      single injection and sufficient ultrasound imaging, and its use is becoming widespread. There
      are studies comparing these two methods. However in this study, we aim to compare the
      postoperative analgesic effects of US-guided costoclavicular technique with US-guided
      supraclavicular technique, which is more common for many years and is performed 2-3 cm
      proximal to the costoclavicular block area.

      During the block application, the US imaging time, the difficulty level of needle imaging,
      the number of maneuvers required to reach the target image, whether additional maneuvers are
      required according to the local anesthetic distribution, the success of the block and the
      duration of the surgery, the total application time of the block and the duration of general
      anesthesia will be recorded. Mean arterial pressure and heart rate will be recorded at
      30-minute intervals during the surgery. Standardized for pediatric patients The FLACC and
      Wong-Baker pain scores will be followed first 24 hours after surgery. The patient will be
      examined for pain, motor and sensation, and analgesic doses will be recorded if used. Time to
      first pain identification, duration of sleep, patient and surgeon satisfaction will be
      recorded.

      The rarely onset of hemidiaphragmatic paralysis during supraclavicular block reduces its use.
      Costoclavicular block could be a safe and effective alternative. One of our seconder
      objectives is to assess the incidence of hemidiaphragmatic paralysis following
      ultrasound-guided supraclavicular block and compare it to that of costoclavicular block. For
      this purpose diaphragmatic excursion is visualized by M-mode ultrasonography 30 minutes after
      extubation. In B-mode, the diaphragm thickness measurement at the end of expiratory and
      inspiratory end is recorded and the diaphragm thickness fraction is calculated. Absence of
      diaphragmatic excursion during a sniff test or sighing defined the hemidiaphragmatic
      paralysis.
    

Detailed description: 
      Peripheral nerve blocks; It is widely used in daily practice for anesthesia or as a part of
      multimodal analgesia in most surgical procedures. In upper extremity surgeries, the brachial
      plexus block can be performed with different techniques at various levels depending on the
      proximal and distal level of the surgery. In this study, the aim is to compare postoperative
      analgesic effects of these two ultrasound-guided techniques in pediatric patients.

      As an alternative to the infraclavicular brachial plexus block, which has been used for many
      years and which we routinely perform to every pediatric patient under general anesthesia;
      Costoclavicular block is recommended due to its advantages such as short application time,
      single injection and sufficient ultrasound imaging, and its use is becoming widespread. There
      are studies comparing these two methods. However, we aim to compare the costoclavicular
      technique with the supraclavicular technique, which is more common for many years and is
      performed 2-3 cm proximal to the costoclavicular block area. Thus demonstrate the safety of
      upper extremity blocks, which is an important part of multimodal analgesia, and to determine
      the most ideal technique in the pediatric patient group who will undergo upper extremity
      surgery.

      During the block application, the US imaging time, the difficulty level of needle imaging,
      the number of maneuvers required to reach the target image, whether additional maneuvers are
      required according to the local anesthetic distribution, the success of the block and the
      duration of the surgery, the total application time of the block and the duration of general
      anesthesia will be recorded. Mean arterial pressure and heart rate will be recorded at
      30-minute intervals during the surgery. Standardized for pediatric patients The FLACC and
      Wong-Baker pain scores will be followed first 24 hours after surgery. The patient will be
      examined for pain, motor and sensation, and analgesic doses will be recorded if used. Time to
      first pain identification, duration of sleep, patient and surgeon satisfaction will be
      recorded.

      The rarely onset of hemidiaphragmatic paralysis during supraclavicular block reduces its use.
      Costoclavicular block could be a safe and effective alternative. One of our seconder
      objectives is to assess the incidence of hemidiaphragmatic paralysis following
      ultrasound-guided supraclavicular block and compare it to that of costoclavicular block. For
      this purpose diaphragmatic excursion is visualized by M-mode ultrasonography 30 minutes after
      extubation. In B-mode, the diaphragm thickness measurement at the end of expiratory and
      inspiratory end is recorded and the diaphragm thickness fraction is calculated. Absence of
      diaphragmatic excursion during a sniff test or sighing defined the hemidiaphragmatic
      paralysis.
    

Intervention name(s): Bupivacaine 0.25% Injectable Solution
Intervention type(s): Drug
Intervention description(s): 1 mg/kg Bupivacaine (0.25%)
Other intervention name(s): Marcaine
Intervention MeSH terms: Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: RANDOMISED DOUBLE BLINDED INTERVENTIONAL
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Screening
Keywords: Postoperative Analgesia; Upper Extremity Surgery; Supraclavicular Block; Costoclavicular Block; Brachial Plexus Block; Ultrasound Guidance