A Curved Block Needle for the Infraclavicular Brachial Plexus Block
Condition: Needle Track
Study type: Interventional

Summary: 
      The investigators hypothesized that using the curved needle could facilitate the block
      placement and provide short procedure time. Aim of the work: The investigators will compare
      namely straight and curved block needle with in-plane needle insertion techniques for the
      infraclavicular brachial plexus nerve block (ICNB) regarding the block performance time.
    

Detailed description: 
      Sometimes, there is a limited block needle access at the inferior edge of the clavicle while
      performing in- plane infraclavicular parasagittal blockade. This might present a challenge in
      manipulating and visualizing the block needle in easy way along its entire trajectory during
      the blockade. The curved block needle might have its positive impact on the capacity to
      control the block needle advancement relative to the target nerve.

      70 patients between the ages of 18 and 60 years with American Society of Anesthesiologists
      (ASA) physical status I- II, scheduled for elective surgery distal to the elbow will be
      enrolled in a prospective, comparative, randomized clinical study.

      Patients will be randomly assigned into two groups: C (n = 35), in whom US-guided single
      injection ICNB will be performed using a curved line needle; and S (n = 35), in whom
      US-guided ICNB will be performed using a straight line needle. All patients will be
      pre-medicated with oral diazepam (7.5 mg) 30 min before the procedure, and IV fentanyl (50
      ug) will be administered 5 minutes before placement of the block. Before the procedure, an IV
      access and standard monitoring of electrocardiogram (ECG), noninvasive blood pressure (NIBP),
      and peripheral oxygen saturation (SPO2) will be established.

      The ultrasound guided Infraclavicular brachial plexus block will be performed in the block
      room using a linear-array US probe (8-13 MHz). The ultrasound probe will be placed just below
      the lower edge of the clavicle and medial to the coracoid process (parasagittal orientation),
      with adjustment of depth, frequency and gain to spot the best view of the transverse axillary
      artery and its surrounding cords (short-axis view).

      After sterile skin preparation with chlorhexidine solution, local infiltration with 2 ml of
      lidocaine (10 mg/ml) will be made at the cephalad aspect of the ultrasound probe. A 10-cm,
      short-bevel block (straight or curved) needle will be attached to the nerve stimulator
      delivering a current of 1.2 mA ( milliampere) at a frequency of 2 Hz (Hertz), will be
      inserted in-plane just inferior to the clavicle.

      After eliciting the posterior cord motor response (finger or wrist extension) with a current
      intensity of ≤ 0.5 mA, correct needle-tip position will be confirmed by test injections with
      1 ml of 5 % dextrose solution. Then, thirty milliliters of local anesthetic mixture
      (lidocaine 10 mg/ml and bupivacaine 2.5 mg/ml) will be incrementally injected after careful
      aspiration. The goal is to ensuring a U-shaped distribution of anaesthetic solution with
      anterior displacement of the axillary artery.
    

Intervention name(s): Curved needle
Intervention type(s): Device
Intervention description(s): In this arm, the curved block needle will be used for regional blockade
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Ultrasound; Regional blockade; Infraclavicular brachial plexus