Early Discharge in Patients Undergoing Elbow Arthroscopy

Study Overview
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Brief Summary
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Patients undergoing elbow arthroscopy surgery will receive standard anesthesia and analgesia (infraclavicular nerve block combined with general anesthesia for surgery; continuous infusion via infraclavicular catheter to day 3 post op). Patients in the experimental group will be discharged home after one day, with infraclavicular catheter in place; patients in the comparator group will stay in hospital for 3 or 4 days, per standard practice. The study will compare range of motion as the primary endpoint, in a non-inferiority design, to see if early discharge is feasible while providing similar recovery.

Official Title
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Outpatient Versus Inpatient Continuous Brachial Plexus Block for Complex Arthroscopic Elbow Surgery: Safety and Functional Outcome

Conditions
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Elbow Arthroscopy Surgery

Intervention / Treatment
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* Procedure: Elbow arthroscopy with infraclavicular nerve block and continuous local anesthetic infusion to day 3 post op.
* Other: Early Discharge
* Other: Normal Discharge


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients undergoing elective complex arthroscopic elbow surgery requiring postoperative CPM - synovectomy, capsulectomy, extensive debridement, contracture release, osteocapsular arthroplasty. ASA I-III Exclusion Criteria: Age>65 Cognitively challenged patients Severe COPD Patients who, on their own or with the assistance of a caregiver, are not confident of being able to remove the local anesthetic infusion catheter at home Psychiatric history Allergy to ropivacaine. Opioid tolerance (>60mg oral morphine or equivalent/day)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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: Early discharge<br>Patients will be discharged home on the first day after surgery, with infraclavicular catheter infusion of local anesthetic in place. | Procedure: Elbow arthroscopy with infraclavicular nerve block and continuous local anesthetic infusion to day 3 post op.<br>* Patients undergoing elbow arthroscopy surgery will receive standard anesthesia/analgesia, including infraclavicular nerve block and general anesthesia for surgery followed by infraclavicular catheter infusion of local anesthetic until day 3 after surgery.<br>Other: Early Discharge<br>* Patients will be discharged home on the first day after surgery, with infraclavicular catheter infusion of local anesthetic in place.<br>|
| Active Comparator: Normal Discharge<br>Patients will remain in hospital and be discharged per current discharge criteria, once the infraclavicular catheter has been removed on day 3 post op. Typical discharge occurs on day 3 or 4 post op. | Procedure: Elbow arthroscopy with infraclavicular nerve block and continuous local anesthetic infusion to day 3 post op.<br>* Patients undergoing elbow arthroscopy surgery will receive standard anesthesia/analgesia, including infraclavicular nerve block and general anesthesia for surgery followed by infraclavicular catheter infusion of local anesthetic until day 3 after surgery.<br>Other: Normal Discharge<br>* Patients will remain in hospital and be discharged per current discharge criteria, once the infraclavicular catheter has been removed on day 3 post op. Typical discharge occurs on day 3 or 4 post op.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Range of Motion | Range of motion at the elbow will be measured vs. baseline to determine surgical success. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post-operative analgesia | Pain scores, by visual analogue scale, will be used to determine patient satisfaction with analgesia to day 3 after surgery. | 3 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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elbow surgery, infraclavicular nerve block, continuous passive motion, ultrasound guided regional anesthesia, early discharge