Selective Trunk Block: A Study to Evaluate Block Dynamics, Effects and Efficacy for Upper Limb Surgery
Condition: Upper Extremity Problem
Study type: Interventional

Summary: 
      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 described to date that can consistently produce
      surgical anesthesia of the whole ipsilateral upper extremity. However, occasionally surgery
      entails that the whole upper extremity, 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. This study is a continuation of
      a previously approved study with title "Selective Trunk Brachial Plexus Block: A Prospective
      Non-Randomized Study of Intervention" [NCT04510259] after the amendment (study title,
      protocol and increased sample size) was rejected by local IRB and suggested to submit as a
      new protocol. 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 described to date that can consistently produce
      surgical anesthesia of the whole ipsilateral upper extremity (shoulder to fingers). 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 (hybrid) techniques. The investigator has
      recently demonstrated that it is feasible to accurately identify majority of the individual
      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 or pass through the three trunks of the
      brachial plexus, the investigator hypothesized that selectively blocking the 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). The investigator refers this novel technique as
      "selective trunk block" (SeTB). Currently there are no published data on block dynamics,
      safety or efficacy of SeTB. 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 interscalene BPB (100%) and supraclavicular BPB
      (50-67%). This study is a continuation of a previously approved study with title "Selective
      Trunk Brachial Plexus Block: A Prospective Non-Randomized Study of Intervention"
      [NCT04510259] after the amendment (study title, protocol and increased sample size) was
      rejected by local IRB and suggested to submit as a new protocol. 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.
    

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