Periarterial Injection Versus Multiple Periveural Injection

Study Overview
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Brief Summary
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In the transarterial technique for axillary brachial plexus block, the axillary artery is intentionally punctured to indicate placement of the needle within the neurovascular sheath; local anesthetic is then injected deep and superficial to the axillary artery.

Detailed Description
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To lessen the risk for hematoma and intravascular injection, several modifications, such as the multi-injection perineural technique, have become popular. These techniques require a high degree of technical skill and multiple needle passes, and also carry potential for injury. In this study, the investigators will compare an ultrasound-guided equivalent of the transarterial technique (periarterial injections) to a commonly used multi-injection perineural technique.

Official Title
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The Ultrasound Guided Periarterial Injection Technique To Axilary Brachial Plexus Block Versus Perineural Multiple InjectionTechnique

Conditions
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Contusion Wrist or Hand, Crush Injury Wrist or Hand

Intervention / Treatment
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* Procedure: US-guided periarterial techique
* Procedure: US-guided multi-injection technique


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: - Patients (ASA physical status I-III) scheduled to undergo hand or wrist surgery under axillary brachial plexus block Exclusion criteria: Patients with pre-existing neuropathy Patients with allergy to local anesthetics Patients with prior surgery in the ipsilateral axilla Pregnant patients Patients with difficulties in communication

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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: US-guided periarterial techique<br>Axillary brachial plexus block by an ultrasound-guided periarterial technique | Procedure: US-guided periarterial techique<br>* The needle will be inserted in the axillary fossa in-plane (cranial to caudal) close to the intersection of the pectoralis and biceps muscles. Two separate injections of local anesthetic will be made deep and superficial to the axillary artery<br>|
| Experimental: US-guided multi-injection technique<br>Ultrasound-guided multi-injection perineural technique for axillary brachial plexus | Procedure: US-guided multi-injection technique<br>* The median, ulnar and radial nerves will be identified by ultrasound. Local anesthetic will be injected adjacent to each nerve<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Block procedure time for the axillary brachial plexus block |  | time of the block achievement will be recorded up to 15 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Onset of the block |  | outcome measure will be measured up to 30 minutes a | 
| Time to request pain medication |  | participants will be followed for 3 days | 
| Block success rate |  | participants success or block failure within 24 hours |