- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01852396
The Retroclavicular Approach for Regional Anesthesia
Ultrasound-Guided Brachial Plexus Regional Anesthesia by the Novel Retroclavicular Approach : A Feasibility Study
Study Overview
Status
Intervention / Treatment
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.
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
Quebec
-
Sherbrooke, Quebec, Canada, J1H 5N4
- Centre Hospitalier Universitaire de Sherbrooke
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Elective or Urgent Surgery of the hand, wrist or forearm
- 18 years and older
- Ability to consent
- American Society of Anesthesiologists class 1 to 3
Exclusion Criteria:
- Infection at the site of infection
- Abnormal anatomy at the site of infection
- Coagulopathy
- Severe Pulmonary Disease
- Preexisting neurological symptom(s) in the operated arm
- Pregnant patients
- Patients weighing less than 50 kg
- Allergy to amide type local anesthetics
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Regional anesthesia
Recruit 50 patient having elbow, forearm, wrist or hand surgery and block brachial plexus using the novel retroclavicular approach
|
Retroclavicular approach ultrasound guided regional anesthesia
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Success Rate of the Block
Time Frame: Assessed 30 minutes after block completion
|
Success is defined as complete sensory loss in the distribution of the radial, median, ulnar, musculocutaneous, and medial cutaneous nerves of the forearm and hand.
|
Assessed 30 minutes after block completion
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Motor Block Progression
Time Frame: Assessed 10, 20, 30 minutes after the block
|
Progress of the motor block in the distribution of the radial, median, ulnar, musculocutaneous nerves of the forearm and hand at 10, 20, and 30 minutes after block completion (mepivacaine injection).
The scale used is: 0: no motor block, 1: paresis, 2: paralysis.
No units are attached to this scale
|
Assessed 10, 20, 30 minutes after the block
|
Patient satisfaction
Time Frame: Assessed 48 hours after the block
|
Using a VAS, patients will quantify their satisfaction with the retroclavicular technique throughout the study period.
|
Assessed 48 hours after the block
|
Duration of the Block's Effects
Time Frame: Assessed 48 hours after the block
|
Duration of the block will be evaluated using 3 criteria: patient's subjective opinion of when the block receded (time of the day), time at which first oral analgesia is taken, and time of first onset of pain.
Units involved is time (for example "3 pm".)
|
Assessed 48 hours after the block
|
Rate of Neurostimulation Usage
Time Frame: Assessed during the block
|
At the discretion of the anesthesiologist performing the block, neurostimulation can be used to supplement ultrasound guidance.
This will be recorded as a YES or NO (neurostimulation used or not).
No units attached to this rate.
|
Assessed during the block
|
Surgical success rate
Time Frame: Defined at the beginning of surgery until the end of surgery
|
Success rate is defined as avoidance of rescue analgesic technique.
These techniques are defined as: adding local anesthetic locally by surgeon, rescue intravenous narcotics in excess of 1 microgram per kilogram of patient weight, need for general anesthesia, rescue distal neural blockage by anesthesiologist.
Data presented will be the need or not of a rescue analgesic technique
|
Defined at the beginning of surgery until the end of surgery
|
Technique duration
Time Frame: Time required in seconds for the retroclavicular block technique completion, assessed during block performance
|
Number of seconds needed to complete the block, from time of local skin anesthesia until regional block needle removal (local skin anesthesia plus injection of mepivacaine)
|
Time required in seconds for the retroclavicular block technique completion, assessed during block performance
|
Needle visualization
Time Frame: Assessed after study completion, once all 50 patients will have been completed. Assessment will take place in the weeks following study completion
|
Using the Likert standardized scale, two evaluators will individually quantify the ease of needle visualization using the video footage recorded by the ultrasound machine from all the retroclavicular blocks.
Likert scale for visualization, is defined as: 1:very bad, 2: bad, 3: adequate, 4:good, 5: very good.
No units are attached to this scale
|
Assessed after study completion, once all 50 patients will have been completed. Assessment will take place in the weeks following study completion
|
Patient discomfort
Time Frame: Assessed immediately after the block
|
Using a Visual Analog Scale (VAS), patients will quantify the discomfort they experienced during the block. This assessment will take place in the minutes following mepivacaine injection and block needle withdrawal. The VAS scale is rated from 1-10, 1 being almost no pain and 10 being the worst pain ever. Assessment will be done by an independent person, not taking part in the study. The VAS has no units attached to it. |
Assessed immediately after the block
|
Sensitive Block Progression
Time Frame: Assessed 10, 20, 30 minutes after the block
|
Progress of the sensory block in the distribution of the radial, median, ulnar, musculocutaneous, and medial cutaneous nerves of the forearm and hand at 10, 20 and 30 minutes after block completion (mepivacaine injection).
The scale used is: 0:no sensitive block, 1:analgesia, 2:anesthesia.
No units are attached to this scale.
|
Assessed 10, 20, 30 minutes after the block
|
Complication Rate
Time Frame: Assessed 48 hours after the block
|
With a phone call to the patient at 48 hours after injection of mepivacaine, complications will be searched for (pain at puncture site, paresthesia or paresis in the operated arm, signs of infection at puncture site such as redness or purulent discharge).
Response is classified as YES or NO.
No units attached to this scale.
If patient reports paresthesia or paresis, further questioning over the phone will determine which nerve or cord is involved.
|
Assessed 48 hours after the block
|
Use of narcotic for tourniquet pain
Time Frame: Assessed throughout the surgery
|
If at any point during the surgery, patient complains of tourniquet pain, this will be noted as well as the analgesia given.
Units is time of pain ("3 pm") and analgesia given ("micrograms of fentanyl").
|
Assessed throughout the surgery
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Pablo Echave, Doctor, Université de Sherbrooke
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Other Study ID Numbers
- 13-020 (Fox Chase Cancer Cener)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Describe Novel Approach to Brachial Plexus Anesthesia
-
Government Medical College, HaldwaniCompletedBrachial Plexus Anesthesia
-
University Hospital, BordeauxWithdrawnBrachial Plexus Block | Anesthesia, RegionalFrance
-
University Hospital, AntwerpCompletedSurgery | Anesthesia | Brachial Plexus Block | Nerve BlockBelgium
-
Centre Hospitalier Universitaire Saint PierreNot yet recruitingAnesthesia, Local | Brachial Plexus; Pressure
-
Charite University, Berlin, GermanySuspendedAnesthesia, Local | Brachial Plexus Block | Nerve BlockGermany
-
Ondokuz Mayıs UniversityCompletedAnesthesia, Local | Brachial Plexus Block | Nerve BlockTurkey
-
Centre Hospitalier Universitaire de BesanconCompletedDexamethasone | Ropivacaine | Anesthesia, Conduction | Axillary Brachial Plexus BlockFrance
-
Cliniques universitaires Saint-Luc- Université...Not yet recruitingAdjuvants, Anesthesia | Brachial Plexus Anesthesia
-
Nordsjaellands HospitalRecruitingAnesthesia, Local | Surgery | Brachial Plexus Block | Nerve Block | Forearm FractureDenmark
-
Nepal Medical College and Teaching HospitalRecruitingBrachial Plexus Block | Upper Extremity Fracture | Local Anesthesia AdjuvantsNepal
Clinical Trials on Retroclavicular block
-
Hôpital du ValaisCompletedHand InjurySwitzerland
-
Brigham and Women's HospitalCompletedPhrenic Nerve ParalysisUnited States
-
Université de SherbrookeCompleted
-
Université de SherbrookeCompleted
-
Sohag UniversityCompleted
-
New Valley UniversityNot yet recruitingDuration of Sensory and Motor Block
-
Antalya Training and Research HospitalCompletedDisorder of Upper ExtremityTurkey
-
Antalya Training and Research HospitalCompletedDisorder of Upper ExtremityTurkey
-
Kahramanmaras Sutcu Imam UniversityUnknownForearm Injuries | Hand Injuries
-
Brigham and Women's HospitalWithdrawnAnesthesia | Upper Extremity InjuryUnited States