Medial Versus Lateral Approach in Ultrasound (US)-Guided Supraclavicular Block

Study Overview
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Brief Summary
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The ultrasound guided supraclavicular block is a peripheral nerve block which is considered safe, has a fast onset, is dense and provides complete block of the nerves supplying the hand, forearm and arm. However retrospective studies done at Toronto Western Hospital have highlighted the fact that most commonly the ulnar nerve fibres (responsible for sensations in the ring finger, little finger and the corresponding part of hand), sometimes escape this block and need additional supplementary block at a distal peripheral nerve site. It is a confusing fact since all nerve fibres are compactly arranged in a sheath at the supraclavicular level. The local anaesthetic agent at this level should be equally distributed among all nerve fibres. The purpose of this study is to compare two different approaches (medial and lateral) adopted by our clinicians to perform this block and to test the effectiveness of each approach for successful ulnar nerve fibre blockade.

Official Title
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Medial vs. Lateral Approach to Ultrasound-Guided Supraclavicular Block: A Prospective Randomized Controlled Trial

Conditions
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Hand or Arm Surgery

Intervention / Treatment
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* Procedure: Lateral-to-Medial Approach
* Procedure: Media-to-Lateral Approach


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients presenting for upper limb surgery, excluding shoulder surgery Age 18-80 yrs BMI < 35 ASA I - III Consent for the study Exclusion Criteria: Pre-existing sensory or motor neurodeficit. Sensitivity to local anaesthetic agents. Patients on anticoagulants or antiplatelet medications (Minidose Aspirin is acceptable) with abnormal coagulation profile. Compromised pulmonary reserve due to COPD, Kypho-scoliosis or Restricted lung disease. Infection or any obvious pathology at the site of block performance History of drug abuse. Psychiatric disease or any condition that precludes an informed consent.

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

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Lateral-to-Medial Approach<br>Needle approach to the brachial plexus nerves will be made using a lateral-to-medial direction. | Procedure: Lateral-to-Medial Approach<br>* Approach of the needle to administer the brachial plexus nerve block will be done in a lateral-to-medial direction.<br>|
| Experimental: Medial-to-Lateral Approach<br>Needle approach to the brachial plexus nerves will be made using a lateral-to-medial direction. | Procedure: Media-to-Lateral Approach<br>* Approach of the needle to administer the brachial plexus nerve block will be done in a medial-to-lateral direction.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Successful block of the Ulnar nerve (C8,T1) fibres. Sensory block with a score of '1' at 30 minutes (loss of sensation to pin prick) is considered successful. |  | 1 hour prior to surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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upper limb, hand, arm, surgery, supraclavicular nerve block, brachial plexus nerve block, ultrasound-guided regional anesthesia