Ulnar Nerve Block for Procedural Anesthesia - Wrist Versus Palm

Study Overview
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Brief Summary
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Ulnar nerve blockade is necessary for sensory anesthesia and analgesia in the hand during minor procedures. The course of the ulnar nerve in the forearm, wrist, and hand is predictable and has low variability. However even with known anatomic location and landmarks, ulnar nerve blocks at the wrist frequently are inadequate for procedural anesthesia. The antebrachial fascia at the wrist acts as a barrier to local infiltration. Since the fascia can not be visualized or palpated, it is commonly not penetrated, resulting in an inadequate block. Furthermore at the level of the wrist the ulnar artery lies in close proximity to the nerve and there is potential for arterial puncture while attempting injection for volar wrist block. The palmar ulnar nerve block is an injection distal to the hook of the hamate in the thenar eminence which avoids the ulnar artery and antebrachial fascia. This block has been used successfully for many years in clinical practice but has not been assessed or compared in a research study. The purpose of this study is to assess the validity of using a palmar ulnar nerve block for procedures in the hand as compared to the standard volar wrist ulnar nerve block.

Official Title
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Ulnar Nerve Block for Procedural Anesthesia - Wrist Versus Palm

Conditions
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Hand Surgery

Intervention / Treatment
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* Procedure: Volar Wrist Block
* Procedure: Hypothenar Palm block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: any individual who can give informed consent and is scheduled for elective hand procedures by the PI necessitating an Ulnar nerve block of the hand. Exclusion Criteria: patients unable to give informed consent patients with previous or ongoing ulnar nerve deficits or neuropathy patients undergoing Guyon's canal decompression patients who can not comprehend or cooperate with assessment testing patients with abnormal two point discrimination (> 6 mm at the test location) prior to the nerve block

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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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Hypothenar Palm block<br>Hypothenar Palmar block group. Local anesthetic is placed at this location in this study group. The same local composition (Intervention) is used for both study groups. The trial is a comparison of location not the Intervention. | Procedure: Hypothenar Palm block<br>* Injection at Hook of the Hamate on Palmar surface Local Block - total 3 cc injection (1.5 cc 1% plain lidocaine and 1.5 cc of 0.25% bupivicaine)<br>|
| Active Comparator: Volar Wrist Block<br>Volar Wrist block group. Local anesthetic is placed at this location in this study group. The same local composition (Intervention) is used for both study groups. The trial is a comparison of location not the Intervention. | Procedure: Volar Wrist Block<br>* Injection medial to Flexor Carpi Ulnaris Tendon at volar proximal wrist crease Local Block - total 3 cc injection (1.5 cc 1% plain lidocaine and 1.5 cc of 0.25% bupivicaine)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Primary outcome is efficacy of sensory anesthesia and analgesia |  | 15-45 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Secondary outcome is patient perceived discomfort with block |  | 15-45 Minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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anesthesia, local, ulnar nerve, hand, surgery, plastic, blinded, randomized, prospective, local anesthesia, volar wrist block, hypothenar palm block, hand surgery