Ultrasound Guided Supraclavicular Nerve Block

Study Overview
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Brief Summary
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This study will test the hypothesis that sequential injection of 1.5% mepivacaine followed 90 seconds later by 0.5% ropivacaine in ultrasound guided supraclavicular block provides a quicker onset and a longer duration of analgesia than an equi-dose mixture of the two local anesthetics.

Detailed Description
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Patients will be randomized into one of two groups, Group M: Ropivacaine and Mepivacaine - subject will receive two injections before surgery begins. These two injections will consist of the mixture of mepivacaine (15 ml) and ropivacaine (15 ml). Group S: Mepivacaine followed by Ropivacaine. Subjects will receive two injections before surgery begins. One injection will contain mepivacaine (15 ml) and the other will contain ropivacaine (15 ml). On the first, second, and third mornings after surgery,subjects will be asked to rate their pain on a scale of 1 to 10. If the subject is discharged from the hospital, a telephone call will be made to the subject's home to collect this information.

Official Title
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Ultrasound Guided Supraclavicular Nerve Block: Comparison Between a Mixture of Mepivacaine and Ropivacaine, and Sequential Injection of Mepivacaine Followed by Ropivacaine

Conditions
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Local Anesthetic

Intervention / Treatment
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* Drug: Ropivacaine
* Drug: Mepivacaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing upper extremity procedures suitable for supraclavicular anesthesia, including but not limited to oHand surgery oForearm surgery oElbow surgery Age between 18 and 70 years Exclusion Criteria: Contraindications to supraclavicular block Coagulopathy Infection at the needle insertion site Severe chronic obstructive pulmonary disease (COPD) Contralateral pneumothorax or diaphragmatic paralysis Pregnancy Preexisting neuropathy involving the surgical limb Routine opioid use Inability to attain adequate ultrasound images in the supraclavicular area

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 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 |
| --- | --- |
| Active Comparator: Group 1<br>combined group: ropivacaine and mepivacaine mixture: 1:1 volume mixture of 1.5% mepivacaine and 0.5% ropivacaine in 2 syringes (labeled 1 and 2) with 15 mL in each (total, 30 mL) injected in immediate sequence; | Drug: Ropivacaine<br>* ropivacaine (15 ml).<br>Drug: Mepivacaine<br>* One syringe will contain mepivacaine (15 ml)<br>|
| Active Comparator: Group 2<br>sequential group: mepivacaine followed by ropivacaine: syringe 1 containing 15 mL of 1.5% mepivacaine, syringe 2 containing 15 mL of 0.5% ropivacaine (total, 30 mL); syringe 2 was injected with a 90-sec delay after injection of syringe 1. | Drug: Ropivacaine<br>* ropivacaine (15 ml).<br>Drug: Mepivacaine<br>* One syringe will contain mepivacaine (15 ml)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of Analgesia. | The primary outcomes will be the onset time, onset of surgical block, and duration of analgesia. | During surgery: postoperative day 0 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to Complete Motor Block |  | during surgery from induction time to end case time | 
| Time to Onset of First Sensory Block |  | during surgery | 
| Maximum Verbal Response Score (VRS) With Rest | The severity of postoperative pain was assessed by an observer blinded to treatment using a 0- to 10-point verbal response score (VRS): 0 = no pain and 10= worst pain | through post operative day 3 | 
| Maximum Verbal Response Score (VRS) With Movement | The severity of postoperative pain was assessed by an observer blinded to treatment using a 0- to 10-point verbal response score (VRS): 0 = no pain and 10 = worst | through post operative day 3 | 
| Duration of Analgesia | Time from the complete onset of sensory block until first request for an analgesic | from surgery date to postoperative day 1 | 
| Total Opioid Consumption | In morphine equivalent dose | postoperative day 1 to day 3 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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surgery for arm hand or elbow, mepivacaine, ropivacaine, hand surgery, elbow surgery, forearm surgery