Clinical Research of Retrograde Infraclavicular Brachial Plexus Blockade

Study Overview
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Brief Summary
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Brachial plexus block is a frequently used technique for upper extremity surgery. All present approaches and techniques have certain advantages and disadvantages. It's necessary to develop a new approach to brachial plexus block which 1) provides reliable anesthesia, 2) is easy to perform, 3) isn't restricted by posture, 4) provides extensive sensory distribution, 5) causes as few complications as possible, 6) easily place a secured catheter for post-operative analgesia. The investigators established the retrograde infraclavicular brachial plexus block approach. The investigators compared and verified the feasibility, efficacy and safety of this new approach with other classic approaches to brachial plexus block.

Detailed Description
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Traditional brachial plexus block approaches have certain limitations. This study evaluated the effectiveness, safety and feasibility of a new retrograde infraclavicular brachial plexus block as compared with interscalene and supraclavicular approaches. 90 patients scheduled for elective upper limb surgery were recruited and randomized into three groups, 30 for each group. Patients of Group A received retrograde infraclavicular block, interscalene (by Winnie) approach for Group B and supraclavicular (by Kulenkampff) approach for Group C. The retrograde infraclavicular block was performed with the insertion point medial to the coracoid process and the needle advanced to ipsilateral interscalene groove. Neurostimulation was used and 40ml of 0.5% ropivacaine were injected. Sensory block, adverse effects and complications were evaluated and recorded every 5 minutes until 30min after local anesthetic injection. The needle insertion depth, angles in coronary and sagittal planes of Group A were also recorded. Success rate of each nerve sensory block, sensory block result, complications, rate of satisfaction, rate of failure and incidence rate of adverse effects are all compared among groups.

Official Title
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New Approach for Brachial Plexus Block: Clinical Research of Retrograde Infraclavicular Brachial Plexus Blockade

Conditions
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Upper Extremity

Intervention / Treatment
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* Procedure: brachial plexus block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA physical status Ⅰ Ⅱ Scheduled for elective upper extremity surgery Exclusion Criteria: Age <18 yr or >60 yr Body weight <50kg or >100kg Serious brain, heart, lung, liver, kidney diseases or diabetes mellitus Incapability or refusing to be enrolled Infection at the site of puncture, skin ulcer Coagulopathy Contralateral phrenic nerve paralysis, contralateral recurrent laryngeal nerve paralysis or pneumothorax

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: retrograde infraclavicular<br>Patients were received retrograde infraclavicular brachial plexus block. | Procedure: brachial plexus block<br>* 0.5% Ropivacaine 40ml<br>* Other names: NAROPIN® 1.0%;|
| Active Comparator: interscalene<br>Patients were received interscalene brachial plexus block. | Procedure: brachial plexus block<br>* 0.5% Ropivacaine 40ml<br>* Other names: NAROPIN® 1.0%;|
| Active Comparator: supraclavicular<br>Patients were received supraclavicular brachial plexus block. | Procedure: brachial plexus block<br>* 0.5% Ropivacaine 40ml<br>* Other names: NAROPIN® 1.0%;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Success rate of nerve sensory block |  | 30 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Success rate of motor block |  | 30 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Supraclavicular, Interscalene, Infraclavicular, Brachial plexus block, Ropivacaine