Supraclavicular Block vs Retroclavicular Block: Incidence of Phrenic Nerve Paralysis

Study Overview
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Brief Summary
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The aim of this study is to evaluate differences between ultrasound guided supraclavicular versus retroclavicular brachial plexus blocks: two similar brachial plexus nerve block techniques that differ in their needle trajectory and injection site.

Detailed Description
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To date, there has not been a study that has compared clinically the retroclavicular brachial plexus block to the supraclavicular brachial plexus block or other brachial plexus blocks. The aim of this study is to evaluate differences between ultrasound guided supraclavicular versus retroclavicular brachial plexus blocks, with primary focus on the incidence of diminished ipsilateral hemidiaphramatic excursion (ipsilateral phrenic nerve blockade). We will also evaluate differences between the two techniques in the success of producing surgical anesthesia, procedural time to perform the block (including imaging time and needling time), block onset time, ease of quality ultrasound needle visualization, and incidence of paresthesias, vascular puncture and pneumothorax. Lastly, we will observe and compare the distribution of motor and sensory blockade of the two techniques

Official Title
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Ultrasound Guided Supraclavicular Brachial Plexus Block vs Retroclavicular Brachial Plexus Block: Comparison of Impact on Ipsilateral Diaphragmatic Function

Conditions
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Phrenic Nerve Paralysis

Intervention / Treatment
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* Procedure: Supraclavicular vs Retroclavicular Nerve Block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients scheduled for lower arm surgery patients aged 18 years or older patients ASA class I-III Exclusion Criteria: Patients unable to cooperate or consent to the study pre-existing neuropathy significant pulmonary disease contralateral phrenic nerve or diaphragmatic dysfunction allergy to local anesthetics infection at needle insertion site history of coagulopathy BMI > 40 kg/m2

Ages Eligible for Study
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Minimum Age: 18 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: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Supraclavicular BPNB<br>Patients in this group will be randomized to receive an Ultrasound Guided Supraclavicular Brachial Plexus Nerve Block and outcomes will be measured over the perioperative and 1day time period. | Procedure: Supraclavicular vs Retroclavicular Nerve Block<br>* An ultrasound-guided supraclavicular or retroclavicular nerve block with 30 ml of 0.5% ropivicaine will be performed on patients scheduled for lower arm surgery; 25 ml to be delivered to the brachial plexus and 5 ml to the intercostal nerve<br>|
| Active Comparator: Retroclavicular BNPB<br>Patients in this group will be randomized to receive an Ultrasound Guided Retroclavicular Brachial Plexus Nerve Block and outcomes will be measured over the perioperative and 1day time period. | Procedure: Supraclavicular vs Retroclavicular Nerve Block<br>* An ultrasound-guided supraclavicular or retroclavicular nerve block with 30 ml of 0.5% ropivicaine will be performed on patients scheduled for lower arm surgery; 25 ml to be delivered to the brachial plexus and 5 ml to the intercostal nerve<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of IIpsilateral Diaphragmatic Paresis | As evidence by ipsilater diagphragmatic excursion measured by Mmode ultrasound | 30 minutes post block, then postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Anesthetic and analgesic efficacy | Block success will be defined as onset of acceptable sensory and motor blockade | 30 minutes post block, then postoperatively | 
| Procedural times (imaging time and needling time), onset time, ease of placement, and block duration | Ultrasonographic block imaging times (time between ultrasound probe placement on the patient and satisfactory image of target anatomy acquisition. needling time (time between needle insertion into the skin and the end of local anesthetic injection through the block needle), onset and duration of sensory block, and proceduralist's rating of ease of block performance will be measured. | at the time of block | 
| Complication rates | Rates of vascular puncture, pneumothorax and paresthesias will be recorded | 1 day | 
| Nerve block distribution | measured through sensation (cold and pin prick) over dermatomes of the brachial plexus | 30 minutes post block | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Retroclavicular, Supraclavicular, Diagphram, hemiparesis, nerve block, regional anesthesia, anesthesiology