Dual Endpoint Nerve Stimulation Versus Ultrasound in Infraclavicular Block for Hand Surgery

Study Overview
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Brief Summary
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Current best practice for performance of infraclavicular block dictates the use of a dual-endpoint nerve stimulation technique that still only results in a 79% success rate. Use of an ultrasound-guided technique has the potential to significantly improve success. A randomized, controlled study to evaluate this area remains to be performed and is required to demonstrate to anesthesiologists that an ultrasound-guided approach should supersede nerve stimulation as the technique of choice for infraclavicular block.

Official Title
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A Randomized Controlled Study Comparing Dual Endpoint Nerve Stimulation With Ultrasound-guided Infraclavicular Block for Hand Surgery.

Conditions
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Hand Surgery

Intervention / Treatment
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* Procedure: Ultrasound Guided Infraclavicular Nerve Block
* Procedure: Dual-Endpoint nerve stimulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing elective upper limb surgery at or below the elbow. Patients aged >18 and <80 years ASA I-III BMI<35 Exclusion Criteria: Inability to read, write or speak English. (This is necessary because subjects will have to follow detailed instructions to allow testing of motor and sensory function. It is not feasible to have an interpreter present in the block room during performance of these procedures) Contraindication to brachial plexus block Existing neurological deficit in the area to be blocked Known loco-regional malignancy or infection Coagulopathy Allergy to local anesthetic agents. Chest or shoulder deformities Severe respiratory disease Healed but dislocated clavicle fracture

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: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Ultrasound<br>Ultrasound guided infraclavicular block | Procedure: Ultrasound Guided Infraclavicular Nerve Block<br>* Use of Ultrasound to help guide needle placement and local anesthetic injection during infraclavicular nerve block.<br>|
| Active Comparator: Dual Endpoint Nerve Stimulator<br>Nerve stimulator guided dual endpoint infraclavicular block | Procedure: Dual-Endpoint nerve stimulation<br>* Use of dual-endpoint nerve stimulation to guide needle placement and local anesthetic injection during infraclavicular nerve block.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To compare ultrasound-guided infraclavicular block with conventional dual-endpoint nerve stimulator guided infraclavicular block with regards to block success, ease of nerve localization, speed of onset, duration of block and complications. |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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infraclavicular nerve block ultrasound dual endpoint stimulation