Continuous Infraclavicular Nerve Blocks: Needle Versus Catheter Local Anesthetic Bolus

Study Overview
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Brief Summary
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The investigators propose to test the hypothesis that when placing a perineural catheter for a continuous peripheral nerve block, injecting the initial local anesthetic bolus via the insertion needle results in a faster-onset sensory block than injecting the initial bolus via the perineural catheter. The study results will help define the optimal local anesthetic bolus introduction technique-needle versus catheter-for peripheral nerve blocks when placing a perineural catheter.

Detailed Description
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Specific Aim: The investigators propose to test the hypothesis that when placing a perineural catheter for a continuous peripheral nerve block, injecting the initial local anesthetic bolus via the insertion needle results in a faster-onset sensory block than injecting the initial bolus via the perineural catheter. The study results will help define the optimal local anesthetic bolus introduction technique-needle versus catheter-for peripheral nerve blocks when placing a perineural catheter.

Official Title
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Continuous Infraclavicular Nerve Blocks: Needle Versus Catheter Local Anesthetic Bolus

Conditions
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Nerve Block

Intervention / Treatment
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* Procedure: Local Anesthetic given via perineural catheter for infraclavicular nerve block.
* Procedure: Local Anesthetic given via needle for infraclavicular nerve block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age ≥ 18 years willing to have bilateral infraclavicular blocks/catheters placed Exclusion Criteria: current daily analgesic use opioid use within the previous 4 weeks any neuro-muscular deficit of either upper extremity body mass index > 30 kg/m2 weight < 50 kg [100 lbs] pregnancy incarceration

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: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Local Anesthetic Via Catheter<br>30mL of Lidocaine (local Anesthetic) will be injected via a perineural catheter at hour 0. | Procedure: Local Anesthetic given via perineural catheter for infraclavicular nerve block.<br>* Patients will be randomized to receive 30mL of Lidocaine via Catheter for an infraclavicular nerve block on one side (right or left) and via needle on the other side. Sensory and strength will be tested following local anesthetic administration.<br>|
| Active Comparator: Local Anesthetic Via Needle<br>30mL of Lidocaine (local Anesthetic) will be injected via a needle at hour 0. | Procedure: Local Anesthetic given via needle for infraclavicular nerve block<br>* Patients will be randomized to receive 30mL of Lidocaine via Catheter for an infraclavicular nerve block on one side (right or left) and via needle on the other side. Sensory and strength will be tested following local anesthetic administration.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sensory Level | EKG pads will be positioned in the 5 major nerve distributions distal to the elbow, ensuring placement is equivalent bilaterally. The primary endpoint will be the time, in minutes, until all 5 nerve territories record > 60 mA, or 120 minutes-whichever occurs first-since 60 mA is estimated to be equivalent to a surgical incision. | 120 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Grip Strength | Evaluated using a portable isometric force dynamometer to measure the maximum voluntary isometric contraction (MVIC) of the hand/fingers. Subjects will be asked to take 2 sec to come to maximum effort, maintain this effort for 3 sec, and then relax. | 120 Minutes | 
| Sensory level for individual nerves | Evaluated using transcutaneous electrical stimulation (TES) in the same manner as described for the primary end point. | 120 Minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Infraclavicular, Nerve Block, Needle, Perineural Catheter, Volunteer, Upper Extremity Nerve Block, Sensation, Strength