Ultrasound Guided Supraclavicular Brachial Plexus Block, Volume Comparison of Local Anaesthetics and Diaphragmatic Motility.

Study Overview
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Brief Summary
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Brachial plexus block as done by landmark technique use large volume of local anaesthetics (at least 30-40 ml), leading to higher incidence of phrenic nerve involvement and diaphragmatic dysfunction. With use of ultrasound dose of local anaesthetic can be reduced. Volume as low as 20 ml when use by ultrasound guidance has shown to provide successful block with no hemidiaphragmatic palsy when compared with nerve stimulation technique. But no study has compared the different volumes of drug on success rate and diaphragmatic motility.So in this study , the investigators want to compare the incidence of hemidiaphragm paralysis and success of block with different volumes of local anaesthetic , so that the lowest effective dose with higher safety profile can be determined.

Official Title
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Effects of Various Volume of Local Anaesthetic Use for Ultrasound Guided Supraclavicular Brachial Plexus Block on Successful Blockade and Diaphragmatic Motility.

Conditions
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Sucessful Block With Less Hemidiaphragmatic Paresis in Distal Upper Arm Fracture

Intervention / Treatment
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* Procedure: ultra sound guided supraclavicular brachial plexus block


Participation Criteria
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Eligibility Criteria
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Inclusion Age between 18 and 60 years undergoing distal arm surgery American Society of Anesthesiologists physical status 1 to 3 Able to give informed consent Body weight greater than 50 kg Exclusion Patient refusal for supraclavicular block. Inability to obtain informed consent. Contraindication to Brachial plexus block Pulmonary and cardiac disorders Pregnancy Allergy to local anesthetic Chest or shoulder deformities

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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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: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 20ml of 0.75% Ropivacine<br> | Procedure: ultra sound guided supraclavicular brachial plexus block<br>* ultra sound guided supraclavicular brachial plexus block , comparing the volume of 0.75 % ropivacine in sucessful block and hemidiaphragmatic motilty.<br>|
| Experimental: 25ml of 0.75% Ropivacine<br> | Procedure: ultra sound guided supraclavicular brachial plexus block<br>* ultra sound guided supraclavicular brachial plexus block , comparing the volume of 0.75 % ropivacine in sucessful block and hemidiaphragmatic motilty.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| hemidiaphragmatic paralysis | grading of hemidiaphragmatic paralysis as, complete ,partial and no hemidiaphragmatic paralysis as reduction of diaphragmatic excursion greater than 75%, 25-75%, less than 25% respectively after sucessful blocade. | within 30 minutes after sucessfull blocade | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| sucessful blocade | ultrasound guided supraclavicular brachial plexus block using ropivacine and observing the complete block. | within 30 minutes of block |