Parasagittal Vs Cornerpocket Approaches

Parasagittal Vs Cornerpocket Approaches for Ultrasound Guided Supraclavicular Brachial Plexus Block A Comparative Study

Brachial plexus blocks are widely used to provide anesthesia for upper limb surgery.

Although many different approaches to the brachial plexus block have been described, there is widespread acceptance that injecting at the supraclavicular level is the most reliable method in terms of spread of local anesthetic agent.

Each approach of ultrasound guided supraclavicular brachial plexus block (US -SCBPB ) has a different success rate and complications. .

A supraclavicular block can provide effective surgical anesthesia of the forearm and hand.

The most commonly performed US- SCBPB is the corner pocket approach which was described by Chan et al with probe resting posterior to the clavicle, with postero latero-anteromedial orientation provides a very stable location, but has the disadvantage of "looking" across the first rib, with the apex of the lung visualized close to thePlexus .

A new Parasagittal approach for brachial plexus block at the supraclavicular level was studied by Adrian Searle where the arc of the first rib was used to provide a deep limit to needle transit in order to minimize the risk of pneumothorax ;the aim of our study is to further evaluate the parasagittal approach for brachial plexus block and compare it with the popular corner pocket approach

Study Overview

• Status: Not yet recruiting
• Conditions: Supraclavicular Brachial Plexus Block
• Intervention / Treatment: Procedure: supraclavicular ultrasound guided brachial plexus block

Detailed Description

After approval of research ethics committee of Sohag University hospital, a written consent will be taken from all participants to use their data for research and educational purposes The study will be carried on 80 participants who undergo elective upper limb surgery for a comparative study.

In this study the investigators will use A 22 G Spinal needle , a high frequency linear probe of US and 2 % lidocaine and 0.5% bupivacaine as local anathetics ,Every participant will be informed about advantages and disadvantages of the research and has the right to withdraw at any stage without negative impact on medical service production.

For both types of block:

Wide bored cannula is inserted,Monitoring is applied (pulse,Ecg,Bp) Oxygen mask 5 liters , Participants were positioned supine with the head turned to the non-operative Side ( contralateral side), and a pillow under the head and shoulder with the ipsilateral arm placed adducted by the patient side.

After that we sterilize the skin and apply a local anesthetic (2-3 ml of2% lidocaine).

The total volume of the local anesthetic mixture was 30 ml (10 ml of 2% lidocaine mixed with 20 ml of 0.5% bupivacine ) Then participants will be divided randomly into 2 groups ,each group 40 participants.

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Nada t Ahmed, resident; Phone Number: 01069459544; Email: nada_abdelrohman@yahoo.com
• Study Contact Backup: Name: Wael A Mahmoud, assistant professor; Phone Number: 01020363508

Study Locations

• Egypt
  • Sohag, Egypt
    • Sohag University Hospital
    • Contact: Magdy M Amin, Professor

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• 18 to 60 years old
• ASA grade I to II
• Elective upper limb surgery

Exclusion Criteria:

• Patient refusal.
• Patient with neurological deficit in the limb of surgery
• Patients with psychiatric disease.
• Coagulopathy.
• Morbid obesity.
• Known allergy to used local anathetics
• Local infection at the block site.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Screening
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: group A; Cornerpocket supraclavicular ultrasound guided brachial plexus block	Procedure: supraclavicular ultrasound guided brachial plexus block; two approaches of ultrasound guided supraclavicular brachial plexus block in upper limb surgery : the cornerpocket supraclavicular brachial plexus block and parasagittal supraclavicular brachial plexus block
Active Comparator: group B; Parasagital supraclavicular ultrasound guided brachial plexus block	Procedure: supraclavicular ultrasound guided brachial plexus block; two approaches of ultrasound guided supraclavicular brachial plexus block in upper limb surgery : the cornerpocket supraclavicular brachial plexus block and parasagittal supraclavicular brachial plexus block

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Needle visibility in both approaches	Measure the visibility of the needles in the ultrasound	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Duration of sensory and motor block	Measure the time of sensory and motor block start to happen after injecting local anathetics	1 year

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Success rate	Measrue number of failed and successful nerve blocks	1 year
Complications	Measure complications of the block	1 year

Collaborators and Investigators

• Sponsor: Sohag University

Publications and helpful links

General Publications

• Duggan E, El Beheiry H, Perlas A, Lupu M, Nuica A, Chan VW, Brull R. Minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2009 May-Jun;34(3):215-8. doi: 10.1097/AAP.0b013e31819a9542.
• Soares LG, Brull R, Lai J, Chan VW. Eight ball, corner pocket: the optimal needle position for ultrasound-guided supraclavicular block. Reg Anesth Pain Med. 2007 Jan-Feb;32(1):94-5. doi: 10.1016/j.rapm.2006.10.007. No abstract available.
• Choi S, McCartney CJ. Evidence Base for the Use of Ultrasound for Upper Extremity Blocks: 2014 Update. Reg Anesth Pain Med. 2016 Mar-Apr;41(2):242-50. doi: 10.1097/AAP.0000000000000155.
• Chan VWS, Perlas A, Rawson R, Odukoya O. Ultrasound-guided supraclavicular brachial plexus block. Anesth Analg. 2003 Nov;97(5):1514-1517. doi: 10.1213/01.ANE.0000062519.61520.14.

Study record dates

Study Major Dates

• Study Start (Estimated): April 2, 2024
• Primary Completion (Estimated): November 1, 2024
• Study Completion (Estimated): January 1, 2025

Study Registration Dates

• First Submitted: April 2, 2024
• First Submitted That Met QC Criteria: April 5, 2024
• First Posted (Actual): April 8, 2024

Study Record Updates

• Last Update Posted (Actual): April 8, 2024
• Last Update Submitted That Met QC Criteria: April 5, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: brachial plexus block
• Other Study ID Numbers: Parasagittal Vs Cornerpocket

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No