Costoclavicular vs Paracoracoid Approach to Infraclavicular Brachial Plexus Block: a Feasibility Study

Study Overview
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Brief Summary
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Patients for upper limb surgeries who are candidates for infraclavicular block will be screened. Two techniques of infraclavicular block will be compared. Measured outcomes are performance times, block onset times, patient satisfaction, quality of block, and requirement for supplementary analgesia.

Detailed Description
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Infraclavicular brachial plexus block under ultrasound guidance is used for surgeries on the upper limb. Traditionally, the block is performed at the lateral infraclavicular fossa where the cords are variable in position relative to the axillary artery. A recently introduced technique is the costoclavicular approach where the cords are viewed as relatively more superficial and clustered together compared to the traditional technique. Those meeting the inclusion criteria and will consent to participate in the study will be randomized to have either an infraclavicular block in the paracoracoid approach (Group 1) or an infraclavicular block in the costoclavicular approach (Group 2). All groups will have the same injectable volume (35 mls) and local anesthetic concentration (ropivacaine 0.5%). There will be 35 study patients for each group for a total of 70 patients.

Official Title
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Costoclavicular vs Paracoracoid Approach to Infraclavicular Brachial Plexus Block: a Feasibility Study

Conditions
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Upper Limb Injury

Intervention / Treatment
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* Drug: Ropivacaine
* Device: Ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Ambulatory elective surgery of the upper limb ASA (American Society of Anesthesiologists physical status classification system) 1-4 Suitable for procedure to be carried out under infraclavicular block Exclusion Criteria: Inability to give informed consent, Allergy to local anesthetics, morphine or fentanyl Ongoing major medical or psychiatric problems Narcotic abuse Peripheral neuropathy or major neurological problems Scarring in area of blockade Inability to co-operate with post-operative evaluation Major coagulopathy Pregnancy and breast-feeding Women of childbearing age who are not taking adequate contraceptive precautions

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: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Costoclavicular<br>Ultrasound-guided infraclavicular block using Ropivacaine 0.5% 35 mL using the costoclavicular approach | Drug: Ropivacaine<br>* Local anesthetic<br>* Other names: Naropin;Device: Ultrasound<br>* Ultrasound guided block<br>|
| Active Comparator: Paracoracoid<br>Ultrasound-guided infraclavicular block using Ropivacaine 0.5% 35 mL using the paracoracoid or standard approach | Drug: Ropivacaine<br>* Local anesthetic<br>* Other names: Naropin;Device: Ultrasound<br>* Ultrasound guided block<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Block onset time | From the time needle is removed from the patient's skin up to the time when block is considered adequate for surgery | 1 hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Procedure duration | From the time the US probe touches the skin to the time the needle is removed | 1 hour | 
| Quality of block |  | 1 hour | 
| Patient satisfaction | Satisfaction score (VAS ranging from 0 = completely dissatisfied to 10 = completely satisfied) | 1 day | 
| Requirement for supplemental analgesia or anesthesia | Quality of block will be assessed if adequate for surgery | 1 day |