Clinical trial NCT02990702: Retroclavicular Approach vs Infraclavicular Approach for Brachial Plexus Block in Obese Patients
Official title: Retroclavicular Approach vs Infraclavicular Approach for Brachial Plexus Block in Obese
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: PHASE4
Conditions: Forearm Injuries
Hand Injuries
Keywords: Infraclavicular block
Retroclavicular block
Ultrasound
Lead sponsor: Kahramanmaras Sutcu Imam University
Sponsor class: OTHER
First posted: 2016-12-13
Enrollment: 60
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL

Brief summary: The retroclavicular approach for brachial plexus anesthesia requires an optimal angle between the needle and the ultrasound beam. Retroclavicular approach has already been proven effective and safe in the past. The general objective is to provide a formal comparison between the retroclavicular approach and coracoid infraclavicular approach for brachial plexus anaesthesia. This study should represent the differences between the two techniques.

Detailed description: Classic infraclavicular approach of the brachial plexus involves a needle puncture below the clavicle and advancing the needle with a 45-60 degree angle from cephalad to caudad. The aim is to advanced the block needle posterior to the axillary artery and to deposit the local anesthetic at that point, near the posterior cord. A "U" shaped spread around the artery should ensure distribution around all three cords. Ultrasound guidance is highly recommended and neurostimulation is optional.

The retroclavicular approach is a variant to this classical technique. Ultrasound probe is positioned initially below the clavicle in a manner similar to the classic approach but is then rotated in a clockwise fashion (right arm) or counter-clockwise fashion (left arm) for about 25-35 degrees. The puncture site is just behind the clavicle at the most lateral point available. If initial entry point is optimal, needle direction is then parallel to ultrasound probe. The final aim and position of block needle is identical to classical approach. Entry point ensures a parallel alignment of the needle and the ultrasound beam, thus enabling almost perfect visualization of both artery, cords and block needle. This is turn optimizes safety, rapidity of technique, efficiency and efficacy.

It is recognized that regional anesthesia is more difficult to perform in obese patients. Anatomic landmarks are harder to localize in this population and ultrasound guidance is more difficult because of the attenuation of the ultrasound beam by adipose tissue. The complication rate of regional techniques is also reported to be higher in the obese patient population.

Eligibility criteria: Inclusion Criteria:

* 18-80 years
* BMI\>30
* Forearm- Hand surgery

Exclusion Criteria:

* \<18 years
* Local infection
* Coagulopaty

Primary outcomes:
measure: Technique duration
timeFrame: Measured directly during the procedure with a chronometer.
measure: Surgery completion under regional block
timeFrame: Success is defined at end of surgery for which block was done, generally within 1 to 3 hours after block is performed
Secondary outcomes:
measure: Sensorial block progression
timeFrame: Assessed 10, 20 and 30 minutes after block completion
measure: Motor Block Progression
timeFrame: Assessed 10, 20, 30 minutes after the block completion
measure: Needle visualization
timeFrame: Assessed one week after study completion
Other outcomes:
Locations:
Study officials:
References: