The Simultaneous Use of Supraclavicular and Distal Blocks

Study Overview
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Brief Summary
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The aim of this study is to compare the combined ultrasound-guided supraclavicular brachial plexus block and distal median, radial, and ulnar nerve blocks, with supraclavicular block alone. Sixty two patients undergoing upper extremity surgery will be randomized to supraclavicular only (Group S, n=31) or supraclavicular + distal (Group SD, n=31) group. Patients in group S will receive 32 mL of lidocaine 1.5% + epinephrine 5µg/mL and in group SD receive 20 mL of lidocaine 1.5% + epinephrine 5µg/mL followed by a distal median, radial, and ulnar nerve blocks using 50:50 mixture of lidocaine 2% + levobupivacaine 0.5% (4 mL/nerve). Sensory and motor block of the ulnar, median, radial and musculocutaneous nerves will be assessed every 5 minutes starting at the 10th minutes. The imaging, needling and performance times will be recorded. Also the onset and anesthesia related times, need for analgesic and first analgesic time will be noted.

Official Title
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Can we Gain an Advantage by Combining Distal Median, Radial and Ulnar Nerve Blocks With Supraclavicular Block? A Randomized Controlled Study

Conditions
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Orthopaedic Disorders, Nerve Block, Anaesthesia

Intervention / Treatment
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* Procedure: intravenous cannulation.
* Procedure: Supraclavicular block and ultrasound-guided ulnar, median and radial nerve blocks.
* Device: Intravenous cannulation.
* Device: Routine ASA monitoring
* Drug: Premedication midazolam
* Drug: Lidocaine
* Drug: Epinephrine
* Drug: Levobupivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 and 80 years old patient American Society of Anesthesiologists (ASA) physical status I-III Scheduled for elective hand and forearm surgery Exclusion Criteria: patient refusal preexisting neuropathy coagulopathy allergy to agents used pregnancy body mass index > 35 kg/m2 chronic obstructive pulmonary disease infection or previous surgery in the supraclavicular area systemic infection

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 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

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: supraclavicular block<br>A supraclavicular block with 32 mL of lidocaine 1.5% + epinephrine 5µg/mL was performed for the anaesthetic management of the forearm and hand. | Procedure: intravenous cannulation.<br>* A 18-or 20-gauge intravenous (iv) catheter was placed to the contralateral arm according to the surgical site<br>Device: Intravenous cannulation.<br>* A 18-or 20-gauge intravenous (iv) catheter was placed to the contralateral arm according to the surgical site<br>Device: Routine ASA monitoring<br>* Monitorization with ECG, noninvasive blood pressure and spO2.<br>Drug: Premedication midazolam<br>* Premedication with 0.03 mg/kg midazolam iv<br>Drug: Lidocaine<br> <br> Drug: Epinephrine<br> <br> |
| Active Comparator: Supraclavicular and median, ulnar, radial blocks<br>Patients in this group received 20 mL of lidocaine 1.5% + epinephrine 5µg/mL for supraclavicular block and after the supraclavicular block they recieved a distal median, radial, and ulnar nerve blocks using 50:50 mixture of lidocaine 2% + levobupivacaine 0.5% (4 mL/nerve). | Procedure: Supraclavicular block and ultrasound-guided ulnar, median and radial nerve blocks.<br>* Supraclavicular block with 20 mL of lidocaine 1.5% + epinephrine 5µg/mL and the addition of ultrasound-guided ulnar, median and radial nerve blocks. For that 12 mL of local anesthetic solution of a 50:50 mixture of lidocaine 2% and levobupivacaine 0.5% (4 mL/nerve) was used.<br>Device: Intravenous cannulation.<br>* A 18-or 20-gauge intravenous (iv) catheter was placed to the contralateral arm according to the surgical site<br>Device: Routine ASA monitoring<br>* Monitorization with ECG, noninvasive blood pressure and spO2.<br>Drug: Premedication midazolam<br>* Premedication with 0.03 mg/kg midazolam iv<br>Drug: Lidocaine<br> <br> Drug: Epinephrine<br> <br> Drug: Levobupivacaine<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The time required after a supraclavicular block alone or a supraclavicular block combined with distal blocks, to achieve a sensory and motor block needed for surgery. | The onset time of supraclavicular plexus block and the onset time of supraclavicular block combined with distal median, radial, and ulnar nerve blocks will be followed up. The time needed to achieve a surgical block will be assessed in both groups. The difference between the 2 groups will be compared and analysed. For this an investigator blinded to the group allocation will evaluate the sensorial pinprick and motor blocks of the ulnar, median, radial and musculocutaneous nerves every 5 minutes starting at the 10th minutes until 30th minutes. | All patients will be followed up during the block procedure and during the surgery. Also, after the surgery patients will be followed up to 7 days postoperatively. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ultrasound, peripheral nerves, anesthetics, local