Comparison of Lateral and Medial Approaches to Costoclavicular Brachial Plexus Block 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. In
      this study, we aim to compare the different approaches of US guided costoclavicular
      technique. Lateral approache is more common for the costoclavicular block area. However, more
      needle maneuvers are needed especially in pediatric patients because of the coracoid process.
      Medial approach is recommended to overcome this problem. 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 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.
    

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. In this
      study, we aim to compare the different approaches of US guided costoclavicular technique.
      Lateral approache is more common for the costoclavicular block area. However, more needle
      maneuvers are needed especially in pediatric patients because of the coracoid process. Medial
      approach is recommended to overcome this problem. 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 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.
    

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; Costoclavicular Block; Brachial Plexus Block; Ultrasound Guidance