Retroclavicular Versus Costoclavicular Approach for Infraclavicular Brachial Plexus Block

Study Overview
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Brief Summary
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The primary aim of this study is to compare needle shaft visibility between the retroclavicular approach and costoclavicular approach for infraclavicular brachial plexus block in patients undergoing elective upper limb surgery. Secondary aim is to investigate the differences between the two groups in sensorial block success rate, block performance time, block performance related pain, motor block success rate, surgical success rate, complications, patient satisfaction, use of supplemental local anesthetic, use of analgesic.

Detailed Description
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Infraclavicular blocks are performed with different approaches. This study evaluated the effectiveness, safety and feasibility of a retroclavicular brachial plexus block as compared with costoclavicular approach for infraclavicular brachial plexus block. 60 patients scheduled for elective upper limb surgery were recruited and randomized into two groups: Retroclavicular approach for infraclavicular block (Group I), costoclavicular approach for infraclavicular block (Group R). Sensory block, adverse effects and complications were evaluated and recorded every 5 minutes until 30 min after local anesthetic injection. Success rate of each nerve sensory block, complications, rate of satisfaction, rate of failure and incidence rate of adverse effects, the needle shaft visibility, procedure time,duration of the block's effect, use of supplemental local anesthetic, use of analgesic are compared with both groups.

Official Title
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A Randomized Controlled Trial Comparing Retroclavicular and Costoclavicular Approach for Infraclavicular Brachial Plexus Block

Conditions
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Disorder of Upper Extremity

Intervention / Treatment
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* Other: retroclavicular approach
* Other: costoclavicular approach


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients who undergo elective forearm or hand surgery under infraclavicular brachial plexus block American Society of Anesthesiologists class 1 to 3 Ability to consent Exclusion Criteria: History of allergic reaction to local anaesthetics Peripheral neuropathy Renal or hepatic insufficiency Coagulation disorders

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: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: retroclavicular approach<br>Patients in this group will be randomized to receive an retroclavicular approach to Ultrasound Guided Infraclavicular Brachial Plexus Nerve Block . | Other: retroclavicular approach<br>* Retroclavicular approach for ultrasound guided infraclavicular brachial plexus block<br>|
| Active Comparator: costoclavicular approach<br>Patients in this group will be randomized to receive an costoclavicular approach to Ultrasound Guided Infraclavicular Brachial Plexus Nerve Block . | Other: costoclavicular approach<br>* costoclavicular approach for ultrasound guided infraclavicular brachial plexus block<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Needle shaft visibility | Needle visibility reviewed by two anesthesiologists using a 5-point Likert scale | 10 minutes after the needle inserted the skin | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Technique duration | Number of seconds needed to complete the block, from time of local skin anesthesia until regional block needle removal. | Time required in seconds for the block completion (10 minutes) | 
| Patient satisfaction using a visual analogue scale | Using a visual analog scala, patients will quantify their satisfaction with the retroclavicular and costaclavicular technique . | Assessed 24 hours after the block | 
| supplemental analgesic used | The use of supplementary local anesthetic and the use of intravenous narcotics were recorded. | 90 minutes after block completion | 
| complications such as pneumothorax, hemothorax, intraarterial injection, intravenous injection | Asked about possible complications | 24 hours | 
| motor block success rate | Success is defined as complete motor block in the distribution of the radial, median, ulnar, musculocutaneous nerves of the forearm and hand | Assessed 40 minutes after block completion | 
| Success Rate of the sensorial Block | Success is defined as complete sensory loss in the distribution of the radial, median, ulnar, musculocutaneous, and medial cutaneous nerves of the forearm and hand | Assessed 30 minutes after block completion | 
| Block performance related pain | Block performance related pain was evaluated with a visual analog scala after the removal of the needle. | 10 minutes after the needle inserted the skin | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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infraclavicular brachial plexus block, retroclavicular approach, costoclavicular approach, upper limb surgery, needle shaft visibility