Nerve Stimulator Versus Ultrasound-guided Infraclavicular Block

Study Overview
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Brief Summary
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The investigators compared the postoperative analgesia of nerve stimulator-guided and ultrasound-guided infraclavicular block for upper extremity surgery.

Detailed Description
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Ultrasound (US)-guided peripheral nerve block has increased in popularity. It has many advantages such as improved success rate, faster onset time, fewer needle passes, shorter performance time, and reduced procedural pain and vascular puncture. However, there is no information about postoperative analgesia. Therefore, the investigators tested whether ultrasound-guided peripheral nerve block enhanced the postoperative analgesia for upper extremity surgery compared with nerve stimulator (NS) guidance.

Official Title
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A Randomized Comparison of Nerve Stimulator and Ultrasound-guided Infraclavicular Block for Upper Extremity Surgery

Conditions
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Pain

Intervention / Treatment
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* Procedure: NS-guided infraclavicular block
* Procedure: US-guided infraclavicular block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiologists physical class I - III patients scheduled to undergo upper extremity surgery Exclusion Criteria: coagulopathy, severe pulmonary disease, neuropathy, contralateral diaphragmatic paresis, allergy to study medications

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: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: NS-guided infraclavicular block<br>NS-guided infraclavicular block is performed using 35 ml of 0.5% ropivacaine. | Procedure: NS-guided infraclavicular block<br>* Patients received a standard single injection infraclavicular block using the lateral sagittal approach of Klaastad. The infraclavicular brachial plexus is identified using an insulated needle connected to a nerve stimulator. Placement of the needle is considered adequate if motor response of radial nerve in the hand or wrist is still present at 0.2 - 0.5mA. Ropivacaine 0.5% 35ml is used.<br>|
| Experimental: US-guided infraclavicular block<br>US-guided infraclavicular block is performed using 35 ml of 0.5% ropivacaine. | Procedure: US-guided infraclavicular block<br>* Infraclavicular block is performed under ultrasound guidance. Linear probe is placed in a parasagittal positon below the clavicle medial to the coracoid process and adjusted to achieve a cross-sectional image of the axillary artery. Using in-plane technique, an 22-gauge insulated needle is advanced caudally and posteriorly to the axillary artery. Subsequently, 35 ml of 0.5% ropivacaine is incrementally injected.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of postoperative analgesia | time from completion of local anesthetic injection until the first request for an analgesic | at 24h after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| block performance time | the time between the block needle insertion and needle withdrawal | at 30 min after block placement | 
| number of needle redirections | either forward or backward movement of needle at least 1 cm or more | at 30 min after block placement | 
| patient discomfort | pain score (0-10) during the procedure | at 30 min after block placement | 
| paresthesia | presence of paresthesia during the procedure | at 30 min after block placement | 
| onset time | complete block of sensory nerve (radial, ulnar, median, musculocutaneous, and medial antebrachial cutaneous nerve) | until 30min after completion of local anesthetic | 
| motor block of hand | presence of motor block in the operated hand | at 24h after surgery | 
| postoperative dysesthesia | presence of any paresthesia in the operated extremity | at 24h after surgery | 
| supplemental analgesia | Rescue analgesia with 75 mg of IM diclofenac was available on demand. | at 24h after surgery | 
| Pain score |  | at 24h after surgery | 
| Patient satisfaction | The acceptance of the anesthetic technique was evaluated using a two-point score: 1, satisfactory (if necessary, I would have the same anesthetic technique); and 2, unsatisfactory (different anesthetic technique). | at 24h after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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nerve stimulator, ultrasound