USG Brachial Plexus Block for Upper Extremity Surgery

Study Overview
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Brief Summary
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Ultrasound-guided (USG) brachial plexus (BP) block efficacy at the Supraclavicular (SCL), Lateral- Infraclavicular (LIC) and Axillary (AX) level: Randomized, observer-blinded study of the single-penetration multiple-injection-technique.

Detailed Description
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The investigators will compare the BP block efficacy (for surgical anaesthesia) with the USG single-penetration multiple-injection-technique at the SCL, LIC and AX level for upper-extremity surgery (elbow, forearm, wrist, hand). The investigators want to investigate whether the single-penetration multiple-injection-technique would provide for safe surgical anaesthesia with lower volumes of local anaesthetics than has previously been described in a comparative study at the three different levels. 120 patients will prospectively be randomized to an USG BP block administered as a single-penetration multiple-injection-technique at one of three different levels: (1) SCL (2) LIC (3) AX. Ropivacaine 0.75% (20 mL) will be used for all blocks prior to surgery.

Official Title
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Ultrasound-guided Brachial Plexus Block With the Single-penetration Multiple-injection-technique for Upper Extremity Surgery

Conditions
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Fracture at Wrist and/or Hand Level, Rupture of Tendon of Wrist and Hand, Injuries to the Wrist, Hand and Fingers (S60-S69), Ganglion Cysts, Carpal Tunnel Syndrome

Intervention / Treatment
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* Drug: Ropivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age above 18 years American Society of Anaesthesiology class 1-3 Patients undergoing upper extremity surgery Exclusion Criteria: Inability to cooperate Inability to understand and talk danish Allergic to ropivacaine Infection at site of surgery Neurological dysfunction at site of surgery Severe coagulopathy Drug and alcohol abuse Patients, who can not get a nerve block due to technical difficulty Pregnancy or nursing Body mass index >35

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: USG Supraclavicular block<br>20 ml of ropivacaine 0,75% is administered to brachial plexus at supraclavicular level. | Drug: Ropivacaine<br>* 20 ml in total of 0,75% Ropivacaine is administered to each patient in all three arms.<br>* Other names: Naropin;|
| Active Comparator: Lateral infraclavicular block<br>20 ml of ropivacaine 0,75 % is administered to brachialis plexus at lateral infraclavicular level | Drug: Ropivacaine<br>* 20 ml in total of 0,75% Ropivacaine is administered to each patient in all three arms.<br>* Other names: Naropin;|
| Active Comparator: USG Axillaris block<br>20 ml of ropivacaine 0,75% is administered to plexus brachialis at axillaris level | Drug: Ropivacaine<br>* 20 ml in total of 0,75% Ropivacaine is administered to each patient in all three arms.<br>* Other names: Naropin;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blockade performance time (seconds) |  | Time (seconds) from the time the ultrasound transducer is placed on the skin and until the needle is taken out of the body. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Onset time of blockade (minutes) |  | Time from block completion to complete sensory and motor block is accomplished. | 
| Number of needle passes |  | Number of times the direction of the needle changes while performing the block | 
| Patient reported pain related to needle passes (Scale 0-2) | 0= no pain middle sever pain | Pain related to block performance reported by the patient right after block completion | 
| Duration of time of block postoperatively (hours) |  | Patient reported the time off ending sensory and motory block |