Dynamic Multimodal Monitoring for Ultrasound Guided Peripheral Nerve Blockade

Study Overview
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Brief Summary
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In clinical practice, local anesthetic injection pressure monitoring is performed manually or by a pressure transducer according to the availability of the equipment or preferences of clinicians. To date, no comparative study has measured the advantages of this measure during PNB. The aim of this study is to evaluate injection pressure monitoring in order to reduce the risk of intraneural injection during peripheral nerve blocks

Detailed Description
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Current recommendations for peripheral nerve block (PNB) procedure advocate combining ultrasound guidance and nerve stimulation. Despite these different means of identification, nerves contacts and intraneural injection are frequent. Even rare, nerve damage may occur. The nerve damage may be related to direct trauma with the needle or inadvertent intra-neural injection. High injection pressure of local anesthetic (AL) is an indicator that further characterize the location of the needle in terms of tissue density. In clinical practice, local anesthetic injection pressure monitoring is performed manually or by a pressure transducer according to the availability of the equipment or preferences of clinicians. To date, no comparative study has measured the advantages of this measure during PNB. The aim of this study is to evaluate injection pressure monitoring in order to reduce the risk of intraneural injection. Group 1: ultrasound-guided technique PNB in plane needle approach, nerve stimulator set to sentinel mode. Manual injection pressure control Group 2: ultrasound-guided PNB, in plane approach, Nerve stimulator set to detection mode. Electronic Injection Pressure controlled with low flow local anesthetic during procedure

Official Title
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Monitoring Combining Neurostimulation and Ultrasound Guidance During the Realization of a Peripheral Nerve Block: Value of Objective Measurement of the Pressure of Injection of the Local Anesthetic

Conditions
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Orthopedic Surgery

Intervention / Treatment
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* Procedure: Manual measurement
* Procedure: Measurement with a gauge


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patient Orthopedic surgery Exclusion Criteria: Allergy to local anesthetics ASA score >III Severe neuropathy puncture site disease parturient or breastfeeding

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 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: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Manual measurement by the anesthetist<br>Monitoring by ultrasound, Neurostimulation and Measurement Manual of the injection pressure of the local anesthetic : Group 1 | Procedure: Manual measurement<br>* Monitoring by ultrasound, Neurostimulation and Measurement Manual of the injection pressure of the local anesthetic<br>* Other names: Manual measurement by the anesthetist;|
| Experimental: Measurement by a pressure gauge<br>Monitoring by ultrasound, Neurostimulation and measurement with a gauge of the injection pressure of the local anesthetic : Group 2 | Procedure: Measurement with a gauge<br>* Monitoring by ultrasound, Neurostimulation and measurement with a gauge of the pressure of injection of the local anesthetic<br>* Other names: Measured by a pressure gauge;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Manual measurement | Manual measurement of the pressure of injection of the local anesthetic during surgery for patients in Group 1 | Intraoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Measured by a pressure gauge | Measured by a pressure gauge of the pressure of injection of the local anesthetic during surgery for patients in Group 2 | Intraoperative |