Selective Trunk Brachial Plexus Block
Condition: Upper Extremity Problem
Study type: Interventional

Summary: 
      Brachial plexus block (BPB) is frequently used as the sole anesthestic technique for upper
      extremity surgery. However, the choice of injection can be made from different approaches
      that often depends on the site of surgery because the extent of sensory-motor blockade after
      a BPB varies with the approach used. The investigator is not aware of any single BPB
      technique that can consistently produce surgical anaesthesia of the whole ipsilateral upper
      extremity. However, occasionally surgery entails that the whole upper extremity is
      anesthetized, i.e. from the shoulder to the elbow, or even the forearm, wrist or hands. This
      clinical challenge has been addressed previously using a combination of BPB techniques. The
      investigator has recently demonstrated that it is feasible to accurately identify majority of
      the main components of the brachial plexus above the clavicle, including the three trunks,
      using ultrasound imaging. Since majority of the innervation of the upper extremity, i.e.
      shoulder, arm, elbow, forearm, wrist and hand, originates from the three trunks of the
      brachial plexus, the investigator hypothesized that selectively blocking upper, middle, and
      inferior trunks of the brachial plexus will produce surgical anesthetsia of the whole
      ipsilateral upper extremity. The aim of this study is to assess a novel brachial plexus block
      technique, the selective trunk block (SeTB), and provide preliminary clinical evidence of its
      effectiveness in producing surgical anesthesia of the whole ipsilateral upper extremity.
    

Detailed description: 
      Brachial plexus block (BPB) is frequently used as the sole anesthetic technique for upper
      extremity surgery. The choice of technique often depends on the site of surgery because the
      extent of sensory-motor blockade after a BPB varies with the technique used. The investigator
      is not aware of any single BPB technique that can consistently produce surgical anesthesia of
      the whole ipsilateral upper extremity. However, occasionally surgery entails that the whole
      upper extremity is anesthetized, i.e. from the shoulder to the elbow, or even the forearm,
      wrist or hands. This clinical challenge has been addressed previously using a combination of
      BPB techniques. The investigator has recently demonstrated that it is feasible to accurately
      identify majority of the main components of the brachial plexus above the clavicle, including
      the three trunks, using ultrasound imaging. Since majority of the innervation of the upper
      extremity, i.e. shoulder, arm, elbow, forearm, wrist and hand, originates from the three
      trunks of the brachial plexus, the investigator hypothesized that selectively blocking upper,
      middle and inferior trunks of the brachial plexus will produce surgical anesthesia of the
      whole ipsilateral upper extremity, except for the area innervated by the intercostobrachial
      nerve (T2- medial aspect of the upper arm). In addition, there may be a potential advantage
      that phrenic nerve can be spared, so this blockade will not affect the respiratory function
      as it is common to see phrenic nerve palsy after interascalene BPB (100%) and supraclavicular
      BPB (50-67%). The aim of this study is therefore to assess a novel brachial plexus block
      technique, the "selective trunk block" (SeTB), and provide preliminary clinical evidence of
      its effectiveness in producing surgical anesthesia of the whole ipsilateral upper extremity.
    

Intervention name(s): Selective Brachial plexus Block
Intervention type(s): Procedure
Intervention description(s): It is one type of peripheral nerve blocks for upper extremity surgery. In this study, the block will be done under the ultrasound guidance and the local anesthetic agent (a mixture of 2% Xylocaine with 1: 200,000 adrenaline and 0.5% Chirocaine in a total of 25ml) will be injected at the trunks of the brachial plexus in order to produce the surgical anesthesia of the whole upper extremity of the patients scheduled for upper limb surgeries.
Other intervention name(s): Drug
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Brachial Plexus Block; Upper extremity