Three Techniques for Ultrasound Guided Axillary Brachial Plexus Block

Study Overview
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Brief Summary
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The brachial plexus block is an anesthetic technique often used for surgical procedures of the upper limb. The brachial plexus block through the axilla (BPVA) is one of the techniques most commonly used to obtain regional anesthesia of the upper limbs, being performed by anesthesia of the terminal branches of the brachial plexus, which would be the ulnar, median, radial and musculocutaneous nerves. With the aid of ultrasound , two techniques can be used to perform the BPVA . The first , known as multiple puncture technique , the local anesthetic is deposited around each nerve that want to block . This technique is most commonly used to perform the BPVA . The second technique , known as 2 injections , local anesthetic is deposited below the axillary artery and around the musculocutaneous nerve . This technique has been proposed to try to reduce the execution time of anesthesia . Studies actually show that the technique of 2 injections showed less time to perform the block, with the same success rate. However, the technique of 2 injections showed a longer latency and higher rate of vascular puncture . (14) In order to perform a procedure with shorter execution time , without changing the latency, success rate and ensuring patient safety , the investigators designed this protocol to evaluate three techniques for performing the ultrasound- guided axillary brachial plexus block.

Official Title
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Prospective Randomized Study of Three Different Techniques for Ultrasound Guided Axillary Brachial Plexus Block

Conditions
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Hand Surgery

Intervention / Treatment
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* Procedure: Axillary brachial plexus block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Informed consent signed by the patient (IC) Indication for brachial plexus block for anesthesia and analgesia in candidates for hand surgical procedures ASA physical status I, II or III according to the American Association of Anesthesiology. Exclusion Criteria: Cognitive impairment or psychiatric disease Active infection condition at the puncture site of the block Bleeding disorders History of allergy to bupivacaine.

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: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Around Artery<br>Intervention Name: Axillary brachial plexus block Group A: 30 ml of 0.375% bupivacaine will be injected around the artery . If this were a clock, would deposit 7,5 ml of anesthetic in positions 0, 3, 6 and 9 . | Procedure: Axillary brachial plexus block<br> <br> |
| Experimental: Two injections<br>Group 2: 30 ml of bupivacaine 0.375 % below the artery will be injected in the 6 o'clock position . | Procedure: Axillary brachial plexus block<br> <br> |
| Active Comparator: Perineural<br>Group Perineural : 10 ml of bupivacaine 0.375 % will be injected around the median, ulnar and radial nerves . | Procedure: Axillary brachial plexus block<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The primary outcome is to compare the efficacy of the three different techniques for ultrasound guided axillary brachial plexus block | The brachial plexus block is performed through the axilla , with the aid of ultrasound and a peripheral nerve stimulator with the patient in the supine position. The needle that will be used is 22G x 50 mm . After disinfection and skin antisepsis with chlorhexidine , tha puncture site will be infiltrated with 1% lidocaine . Furthermore, musculocutaneous nerve will be blockade with 10 ml of 0.375% bupivacaine for all patients. Patients will be divided into three groups : Group A: 30 ml of 0.375% bupivacaine will be injected around the artery . If this were a clock, would deposit 7,5 ml of anesthetic in positions 0, 3, 6 and 9 . Group 2 injections : 30 ml of bupivacaine 0.375 % below the artery will be injected in the 6 o'clock position . Group M : 10 ml of bupivacaine 0.375 % will be injected | The primary outcome will be measured at the same day of the procedure. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Block Latency | Latency time of the blockade , defined as the time between the end of injection of local anesthetic will be noted. | 30 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Axillary brachial plexus block, Ultrasound, Bupivacaine