Comparative Study Between Two Different Approaches of Brachial Plexus Block: Supraclavicular Approach and Retroclavicular Approach

Study Overview
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Brief Summary
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In this study investigators will compare two different approaches of brachial plexus block ;supraclavicular approach and retroclavicular approach regarding success rate, duration of block, complications

Official Title
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Comparative Study Between Two Different Approaches of Brachial Plexus Block: Supraclavicular Approach and Retroclavicular Approach

Conditions
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Brachial Plexus Block

Intervention / Treatment
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* Procedure: supraclavicular brachial plexus block
* Procedure: Retroclavicular brachial plexus block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 100 patients doing distal arm surgery, elective , 18 to 60 years old , will be included in double blinded randomized study. Exclusion Criteria: Patient refusal . local infection or deformity at the block site. Patient with significant neurological , psychiatric or neuromuscular disease. Pregnancy or lactating women . Coagulopathy . Morbid obesity . History of allergy to local anaesthetics

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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 |
| --- | --- |
| Active Comparator: Supraclavicular approach group<br>probe placed firmly over the supraclavicular fossa, parallel to the clavicle to obtain a short-axis view of the divisions of the brachial plexus and the subclavian artery, lying on the first rib After skin infiltration with lidocaine 2% a 23-gauge 70mm block needle inserted in-plane with the ultrasound beam, in a lateral-to-medial direction, until the needle tip's positioned at the junction of the first rib and subclavian artery | Procedure: supraclavicular brachial plexus block<br>* group will receive brachial plexus block above clavicle,Injection of anaesthetic will be done in brachial plexus around subclavian artery<br>|
| Active Comparator: Retroclavicular approach group<br>the probe will be placed below and perpendicular to the clavicle, in a paramedian sagittal plane, medial to the coracoid process, to obtain a short-axis view of the cords of the brachial plexus and the axillary vessels. The needle will be then inserted in the supraclavicular fossa, approximately 1 cm posteriorly to the clavicle, and advanced in plane and strictly parallel to the ultrasound transducer. After passing the initial blind zone of about 2 cm caused by the acoustic shadow of the clavicle, the needle tip is constantly seen, until it is positioned posterior to the axillary artery | Procedure: Retroclavicular brachial plexus block<br>* group will receive brachial plexus block inferior to the clavicle,injection of anaesthetic will be done around axillary artery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Block success rate | Investigator will compare success rate of both types of block and which one is more likely to be successfully administrated | one year | 
| Complications | Investigators will compare complications like pneumothorax,nerve injury,bleeding and which one is more likely to cause complications | one year | 
| Duration of sensory and motor blockade | Time which each procedure will take to block sensory and motor stimuli | one year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of procedure | Time which took the investigator to administrate each type of block | one year | 
| Number of needle passes | number of times in which needle has entered been entered into the participant in each group | one year |