- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04506879
Popliteal SNB:Evaluation of Block Dynamics After Subparaneural Injection Below CPN & TN
Ultrasound Guided Popliteal Sciatic Nerve Block: Evaluation of Block Dynamics After a Twin Subparaneural Injection Below the Divergence of Common Peroneal and Tibial Nerve.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Ultrasound (US) guided Popliteal Sciatic Nerve Block (PSNB) has been routinely used to provide surgical anaesthesia for ankle and foot surgeries, and the introduction of ultrasound (US) guidance has improved the ease and accuracy of performing PSNB. However, the challenge of achieving the optimal 'readiness for surgery' time after the US guided PSNB continues to confront anaesthesiologists. Cumulative evidence indicates that a subparaneural PSNB improves sensory motor block outcome when compared to subepimyseal PSNB where the local anaesthetic is deposited outside the paraneural sheath.
While these are encouraging results, producing sensory motor blockade, i.e. surgical anaesthesia in the area innervated by the sciatic nerve within 30 minutes of local anaesthetic (LA) injection, after a subparaneural PSNB, remains a challenge with the success rate varying from 62-92%. Reasons for this shortcoming, despite LA being deposited in subparaneural space, close to the epineurium of the sciatic nerve, is probably multifactorial as the nerve size, surface area exposed to local anaesthetic, and internal architecture (the connective tissue component) of the sciatic nerve and its branches are all seems to influence block onset time and completeness. It was observed from our clinical practice that distal subparaneural injection (twin halo) into individual paraneural sheaths of common peroneal nerve (CPN) and tibial nerve (TN) below the point of divergence at the popliteal fossa demonstrated a faster sensory motor blockade after PSNB. Therefore, this study aims to assess the effect of twin subparaneural injection into individual paraneural sheaths of CPN and TN below their point of divergence from the sciatic nerve on the sensory motor blockade after PSNB at the popliteal fossa.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Winnie Samy, RN, BN, MSc
- Phone Number: +85235052734
- Email: wsamy@cuhk.edu.hk
Study Locations
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New Territories
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Shatin, New Territories, Hong Kong
- Prince of Wales Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- American Society of Anesthesiologists (ASA) physical status I-III scheduled to undergo elective foot and/or ankle surgery under regional anesthesia.
Exclusion Criteria:
- Patient refusal, ASA physical status > Ⅲ, pregnancy, neuromuscular disorder, prior surgery in the popliteal fossa, coagulopathy, allergy to local anaesthetic drugs, and skin infection at the site of needle insertion.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Other: Popliteal Sciatic Nerve block
Patients will lie on their chest on the examination couch with both feet rested on the pillow to relax their lower extremity.
Ultrasound scan of the nerves in popliteal fossa will be identified and then local anesthetic agents [1.5% lidocaine with 1:200,000 adrenaline and 0.5ml of 8.4% sodium bicarbonate (total 30ml)] will be injected close to the nerves (Common peroneal nerve and tibial nerve).
The injections below the bifurcation near the two nerves are expected to produce quicker block than the injections above the bifurcation.
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Patients schedule for lower limb surgery under regional anesthesia will receive ultrasound guided subparaneural popliteal sciatic nerve block.
After identification of the common peroneal nerve and tibial nerve, local anesthetic agents will be injected close to each nerve below the point of divergence at the popliteal fossa.
The spread of the drug and the sensory and motor function of that limb will be assessed regularly till it is ready for surgery.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
the percentage of patients with complete sensory and motor block at 30 min
Time Frame: within 45 minutes after the block (at 5min, 10min, 15min, 20 min, 25min, 30min, 45 min)
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VRS=0 for both sensory and motor score at 30 min.
The extent of the sensory blockade will be graded according to VRS (verbal rating scale) for sensory assessment (100 = normal sensation to 0 = no sensation) in the areas innervated by the sciatic nerve.
Motor blockade of the deep peroneal nerve (dorsal flexion of the ankle) and tibial nerve (plantar flexion of the ankle) will be graded using a 3-point scale: 2 = normal, 1 = paresis, and 0 = paralysis.
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within 45 minutes after the block (at 5min, 10min, 15min, 20 min, 25min, 30min, 45 min)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The time taken to complete sensory and motor blockade at 30 min, time to 'readiness for surgery'
Time Frame: within 45 minutes after the block (at 5min, 10min, 15min, 20 min, 25min, 30min, 45min)
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The time point where the sensory block was =< 30 VRS (VRS 0-100, 100=normal sensation and 0= no sensation) and a motor blockade of =< 1 (2=normal, 1=paresis, 0=paralysis),
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within 45 minutes after the block (at 5min, 10min, 15min, 20 min, 25min, 30min, 45min)
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Success rate of the block
Time Frame: within 45 minutes after the block (at 5min, 10min, 15min, 20min, 25min, 30min, 45min)
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complete abolition of sensation to cold and paralysis of the muscles in the ipsilateral calf and foot
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within 45 minutes after the block (at 5min, 10min, 15min, 20min, 25min, 30min, 45min)
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Complication
Time Frame: from immediately after the block till 24 hours afterwards
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any local anesthetic toxicity
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from immediately after the block till 24 hours afterwards
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Paraesthesia and degree of discomfort
Time Frame: during the block
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Paresthesia (yes or no); degree if discomfort (numeric rating scale 0-100)
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during the block
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Manoj K Karmakar, MD, Chinese University of Hong Kong
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- CREC.2020.314
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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.
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