Influence of Ultrasonographic Hydro-dissection With Glucose 5% on Nerve Block Efficiency (Hydro-Echo)

Influence of Ultrasonographic Hydro-dissection With Glucose 5% Solution on Median Nerve Block Efficiency: a Prospective and Randomized Study

The real-time visualization of a needle and nerve during an ultrasound-guided nerve block can be challenging. These difficulties may partly explain the systemic complications of local anesthetics under ultrasound. Injection of small amounts of a solution around the anesthetized nerve (hydro-dissection) has been proposed to enhance contrast outlining its borders and also to improve the visualization of the needle tip. The glucose solution 5% solution is interesting because it allows, unlike saline, to maintain the motor response with neurostimulation. The hydro-dissection can be particularly useful when one suspect hypoechoic vessels near the nerve to be anesthetized. Thereby, the nerve well demarcated and separated from the vessels, injection of local anesthetic is performed in the circumferential diffusion space (like a small pocket) without redirecting needle.

The influence of this hydro-dissection on the nerve block efficiency is unknown. The nerve block quality can be improved because the entire anesthetic is injected in contact with the nerve, but it can also be reduced due to the dilution of the local anesthetic by the glucose solution.

In this randomized study, the investigators test the hypothesis that hydro-dissection does not alter the nerve block onset time.

Study Overview

• Status: Completed
• Conditions: Nerve Block
• Intervention / Treatment: Procedure: median nerve block; Procedure: median nerve block after hydro-dissection

• Study Type: Interventional
• Enrollment (Actual): 100
• Phase: Phase 4

Contacts and Locations

Study Locations

• France
  • Trappes, France, 78190
    • Hôpital Privé de l'Ouest Parisien

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Adult patients with an ASA physical status I-II scheduled for elective ambulatory surgery of the hand or wrist involving the median nerve

Exclusion Criteria:

• Patients with type 1 or 2 diabetes mellitus,
• History of clinical or laboratory evidence of abnormal bleeding,
• Infection at the injection site,
• Allergy to local anesthetic,
• Preexisting central or peripheral muscular or neurological disease (for example: carpal tunnel syndrome)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: nerve block; median nerve block (6 ml lidocaine 1.5 % with adrenalin 1:200000)	Procedure: median nerve block; median nerve block performed using ultrasound guidance
Experimental: median nerve block after hydro-dissection; median nerve block (6 ml lidocaine 1.5 % with adrenalin 1:200000) after hydro-dissection (glucose 5% solution)	Procedure: median nerve block after hydro-dissection; median nerve block performed after hydro-dissection (glucose 5% solution), both using ultrasound guidance

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Onset time of sensory blockade (light touch test: total loss of sensation at the two distal phalanges of index)	30 minutes after injection

Secondary Outcome Measures

Outcome Measure	Time Frame
Onset time of sensory blockade (cold test at index finger and thenar eminence)	30 minutes after injection
Onset time (light touch test at thenar eminence)	30 minutes after injection
Onset time for motor blockade	30 minutes after injection
Success rate (% of patients with total light touch block at index finger within 30 min evaluation period)	30 minutes after injection
Successful surgical anesthesia	30 minutes after injection
Duration of nerve blockade	12 hours
Nerve block complication	one month
Duration of the puncture procedure	30 minutes after the beginning of the procedure

Collaborators and Investigators

• Sponsor: Hopital Foch

Publications and helpful links

General Publications

• Dufour E, Donat N, Jaziri S, Kurdi O, Couturier C, Dreyfus JF, Fischler M. Ultrasound-guided perineural circumferential median nerve block with and without prior dextrose 5% hydrodissection: a prospective randomized double-blinded noninferiority trial. Anesth Analg. 2012 Sep;115(3):728-33. doi: 10.1213/ANE.0b013e31825fa37d. Epub 2012 Jun 28.

Study record dates

Study Major Dates

• Study Start: January 1, 2010
• Primary Completion (Actual): January 1, 2011
• Study Completion (Actual): January 1, 2011

Study Registration Dates

• First Submitted: January 27, 2010
• First Submitted That Met QC Criteria: January 27, 2010
• First Posted (Estimate): January 28, 2010

Study Record Updates

• Last Update Posted (Estimate): September 23, 2016
• Last Update Submitted That Met QC Criteria: September 22, 2016
• Last Verified: September 1, 2016

More Information

Terms related to this study

• Other Study ID Numbers: 2009/27