- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02718976
Shamrock - Ultrasound/MR Image Fusion Guided Lumbar Plexus Block
The main objective is to complete a double-blinded randomized controlled crossover trial of lumbar plexus block with the Shamrock technique guided by ultrasound (US)/magnetic resonance imaging (MRI) image fusion vs. the Shamrock technique guided by ultrasound in healthy volunteers.
The investigators will assess block procedure-related parameters, anatomical spread of local anesthetic, and motor and sensory effects.
Study Overview
Status
Conditions
Study Type
Enrollment (Actual)
Phase
- Phase 2
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria
- Age ≥ 18 years
- Body mass index (BMI): 18.5 ≤ BMI ≤30
- Written and oral consent to participate
- Normal healthy person (American Society of Anesthesiology Classification I)
Exclusion Criteria:
- Volunteers not abel to speak or understand Danish
- Volunteers not able to cooperate
- Allergy against the medicines used in the study
- Daily use of analgesics
- Drug abuse - according to the investigator's judgment
- Alcohol consumption greater than the recommendations of the Danish National Board of Health
- Contraindication for MRI scan (including pregnancy)
- Volunteers in whom nerve blocks are impossible due to technical reasons or infection
- Volunteers who are incompetent, eg. surrogate consent is unaccepted
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Shamrock guided by US/MR image fusion
Use of US/MR image fusion guided Shamrock technique to place lumbar plexus block (20 ml 2% lidocaine with epinephrine added gadoterate meglumine).
|
Perineural injection of 20 ml 2% lidocaine with 0.0005% epinephrine added 1 ml of gadoterate meglumine (0.13 ml) and sodium chloride (NaCl, 0.87 ml).
The 1 ml of gadoterate meglumine-NaCl is added to the local anesthetic prior to the perineural injection in order to enhance visualization of the local anesthetic on MRI scanning after the intervention.
|
Other: Shamrock guided by US
Use of US guided Shamrock technique to place lumbar plexus block (20 ml 2% lidocaine with epinephrine added gadoterate meglumine).
|
Perineural injection of 20 ml 2% lidocaine with 0.0005% epinephrine added 1 ml of gadoterate meglumine (0.13 ml) and sodium chloride (NaCl, 0.87 ml).
The 1 ml of gadoterate meglumine-NaCl is added to the local anesthetic prior to the perineural injection in order to enhance visualization of the local anesthetic on MRI scanning after the intervention.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of participants with a successful block of the femoral and obturator nerves (reduced muscle force compared to baseline assessed with handheld dynamometer), and of the lateral femoral cutaneous nerve (assessed with cold and pinprick test)
Time Frame: Assessed 60 minutes after intervention. Data will be presented 10 months after study completion.
|
Block success is defined as the number of volunteers with a successful motor block of the femoral nerve and the obturator nerve, and with a successful sensory block of the lateral femoral cutaneous nerve.
Motor block is a proxy marker of sensory block.
A participant with a successful motor block has reduced muscle force after block compared to baseline muscle force assessed with handheld dynamometer, and a participant with a successful sensory block has decreased/absent sensation for cold and/or pinprick.
|
Assessed 60 minutes after intervention. Data will be presented 10 months after study completion.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time for preparation of block procedure (seconds)
Time Frame: Assessed 3 minutes prior to intervention. Data will be presented 10 months after study completion.
|
Time for block preparation is defined as the time period from the time point when the volunteer is placed on the block bed to the time point when the pre-ultrasound scanning before intervention is complete.
|
Assessed 3 minutes prior to intervention. Data will be presented 10 months after study completion.
|
Time for block procedure (seconds)
Time Frame: Assessed 0 minutes after intervention. Data will be presented 10 months after study completion.
|
Time for block procedure is defined as the time period from the time point when the ultrasound probe is placed on the skin after completed preparation to the time point when the block needle is pulled out after injection of local anesthetics (end of intervention).
|
Assessed 0 minutes after intervention. Data will be presented 10 months after study completion.
|
Electrical nerve stimulation strength (mA)
Time Frame: Assessed 1 minute before injection of injectate. Data will be presented 10 months after study completion.
|
Minimal electrical nerve stimulation (mA) required to trigger neuromuscular response and confirm correct placement of block needle prior to injection of local anesthetics.
|
Assessed 1 minute before injection of injectate. Data will be presented 10 months after study completion.
|
Electrical nerve stimulation response (quadriceps, sartorius, other muscular, paresthesia, none)
Time Frame: Assessed 1 minute before injection of injectate. Data will be presented 10 months after study completion.
|
Type of neuromuscular response on electrical nerve stimulation.
|
Assessed 1 minute before injection of injectate. Data will be presented 10 months after study completion.
|
Needle advancements
Time Frame: Assessed 0 minutes after intervention. Data will be presented 10 months after study completion.
|
Number of needle advancements during intervention.
|
Assessed 0 minutes after intervention. Data will be presented 10 months after study completion.
|
Injection site
Time Frame: Assessed 0 minutes after intervention. Data will be presented 10 months after study completion.
|
Assessed 0 minutes after intervention. Data will be presented 10 months after study completion.
|
|
Block needle depth
Time Frame: Assessed 0 minutes after intervention. Data will be presented 10 months after study completion.
|
Assessed 0 minutes after intervention. Data will be presented 10 months after study completion.
|
|
Discomfort
Time Frame: Assessed 0 minutes after intervention. Data will be presented 10 months after study completion.
|
Estimated on numeric rating scale 0-10
|
Assessed 0 minutes after intervention. Data will be presented 10 months after study completion.
|
Mean arterial pressure change
Time Frame: Mean arterial pressure is measured prior to intervention and 5 min after intervention. Data will be presented 10 months after study completion.
|
Mean arterial pressure is measured prior to intervention and 5 min after intervention. Data will be presented 10 months after study completion.
|
|
Number of participants with visual confirmed contact between the injectate and the spinal nerves L2-S1, the femoral, the obturator, and the lateral femoral cutaneous nerves, and the lumbosacral trunk assessed on MRI
Time Frame: Assessed on MRI sampled 10-40 minutes after intervention. Data will be presented 10 months after study completion.
|
Assessed on MRI sampled 10-40 minutes after intervention. Data will be presented 10 months after study completion.
|
|
Number of participants with visually confirmed epidural spread of the injectate assessed on MRI.
Time Frame: Assessed on MRI sampled 10-40 minutes after intervention. Data will be presented 10 months after study completion.
|
Assessed on MRI sampled 10-40 minutes after intervention. Data will be presented 10 months after study completion.
|
|
Number of participants with motor block
Time Frame: Baseline muscle strength is estimated prior to first intervention. Post-block muscle strength is estimated 60 minutes after intervention. Data will be presented 10 months after study completion.
|
Muscle strength of the femoral, obturator, superior gluteal, and sciatic nerves are estimated with handheld dynamometer during knee extension, hip adduction, hip abduction, and knee flexion.
Motor block is assessed as reduced muscle strength compared to baseline.
|
Baseline muscle strength is estimated prior to first intervention. Post-block muscle strength is estimated 60 minutes after intervention. Data will be presented 10 months after study completion.
|
Number of participants with sensory block
Time Frame: Estimated 70 minutes after intervention. Data will be presented 10 months after study completion.
|
Sensory block is defined as decreased or absent sensation for cold, warmth, touch, and pinprick are assessed for the dermatomes T8-S3 and the lateral femoral cutaneous nerve.
|
Estimated 70 minutes after intervention. Data will be presented 10 months after study completion.
|
Cost-effectiveness (ICER)
Time Frame: Calculated 1 month after study completion. Data will be presented 10 months after study completion.
|
ICER is estimated as the difference in mean marginal cost of the blocks.
|
Calculated 1 month after study completion. Data will be presented 10 months after study completion.
|
Quantitative diffusion weighted MRI reproducibility
Time Frame: Assessed on MRI sampled 40-55 minutes after intervention. Data will be presented 10 months after study completion.
|
Assessed on MRI sampled 40-55 minutes after intervention. Data will be presented 10 months after study completion.
|
|
Image evaluation of diffusion weighted MRI reproducibility
Time Frame: Assessed on MRI sampled 40-55 minutes after intervention. Data will be presented 10 months after study completion.
|
Assessed on MRI sampled 40-55 minutes after intervention. Data will be presented 10 months after study completion.
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Jennie MC Strid, M.D., Department of Anesthesiology and Intensive Care, Aarhus University Offical
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
Additional Relevant MeSH Terms
- Pathologic Processes
- Postoperative Complications
- Pain
- Neurologic Manifestations
- Fractures, Bone
- Wounds and Injuries
- Leg Injuries
- Femoral Fractures
- Hip Injuries
- Pain, Postoperative
- Hip Fractures
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Anti-Arrhythmia Agents
- Central Nervous System Depressants
- Autonomic Agents
- Peripheral Nervous System Agents
- Sensory System Agents
- Anesthetics
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Membrane Transport Modulators
- Anesthetics, Local
- Voltage-Gated Sodium Channel Blockers
- Sodium Channel Blockers
- Bronchodilator Agents
- Anti-Asthmatic Agents
- Respiratory System Agents
- Chelating Agents
- Sequestering Agents
- Adrenergic beta-Agonists
- Sympathomimetics
- Vasoconstrictor Agents
- Mydriatics
- Lidocaine
- Epinephrine
- Gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate
Other Study ID Numbers
- AUH-TFB-SR-ULMR
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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