Retroclavicular Block in Vascular Surgey

Efficacy of Retroclavicular Dexamethasone With Bupivacaine in Patients Undergoing Upper Limb Vascular Surgeries

The retroclavicular (coracoid) approach for brachial plexus anesthesia is recognized for its facility and simplicity to perform .

The block has been well described in the anesthesia community since it was first introduced by Hebbard and Royse in 2007 . In 2017, Luftig . first described the block's use in the ED setting for a variety of indications . Because of its different needle entry point, the retro clavicular (RCB) approach offers an almost perpendicular needle-ultrasound (US) beam angle.

Study Overview

• Status: Recruiting
• Conditions: Pain Management
• Intervention / Treatment: Other: retroclavicular block

Detailed Description

Regional anesthesia (RA) offers several advantages over general anesthesia (GA) for upper limb orthopedic surgery. One of the advantages is the improvement in postoperative pain, which leads to decreased use of postoperative opioids needs and reduces the recovery time for patients . A variety of approaches for regional blockade for upper extremity surgery have been described.

Dexamethasone is a corticosteroid drug that has been used as an adjuvant to reduce postoperative pain.

The use of peri neural dexamethasone (i.e. dexamethasone added to the local anesthesia solution) as an adjuvant to peripheral nerve block to improve analgesia provided by local anesthetic alone . Peri neural dexamethasone, as an adjuvant to peripheral nerve block, has been associated with faster onset of anesthesia , longer duration of anesthesia/analgesia decreased postoperative pain intensity and decreased postoperative analgesia requirements compared with local anaesthetic alone . The exact mechanism by which dexamethasone reduces pain is not known. The decrease in pain intensity and the prolonged analgesia attained with the use of perineural dexamethasone may be the result of a local, or systemic action, or both . Dexamethasone may act locally on glucocorticosteroid receptors to induce vasoconstriction, thereby decreasing systemic absorption of local anaesthetics . Other potential mechanisms of action include suppression of C-fibre transmission of pain signals and direct action on the nerve cell to reduce neural discharge . Dexamethasone may act systemically by reducing the inflammatory response caused by surgical tissue injury .

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

Contacts and Locations

• Study Contact: Name: ahmed ismail, lecture; Phone Number: 01097845491; Email: ahmed_ismail87@med.nvu.edu.eg

Study Locations

• Egypt
  • Asyut, Egypt
    • Recruiting
    • Faculty of medicine
    • Contact: hassan abdel lataif, prof

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients undergoing upper limb vascular surgey .

Exclusion Criteria:

• - Contraindications to regional block (coagulopathy, infection at the needle insertion site, or diaphragmatic paralysis).
• Altered conscious level.
• Pregnancy.
• Body mass index (BMI > 35).
• Patients who have difficulty understanding the study protocol.
• Patients who have any known contraindication to study medications.
• Patient refusal.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: dexamethasone with bupivacaine in retroclavicular block; 40patients received 40 ml of bupivacaine 0.25%(in total 100 mg)+1 ml of dexamethasone)	Other: retroclavicular block; regional anesthesia
Active Comparator: bupivacaine in retroclavicular block (control group); : 40patients received. 40 ml of bupivacaine 0.25%(in total 100 mg)+1 ml saline	Other: retroclavicular block; regional anesthesia

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
sensory and motor duration of block	efficacy of block	24 hours

Collaborators and Investigators

• Sponsor: New Valley University
• Investigators: Principal Investigator: ahmed ismail, lecture, faculty of medicine , new valley university

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2024
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: May 6, 2024
• First Submitted That Met QC Criteria: May 8, 2024
• First Posted (Actual): May 9, 2024

Study Record Updates

• Last Update Posted (Actual): May 7, 2026
• Last Update Submitted That Met QC Criteria: May 2, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Perceptual Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Agnosia
• Other Study ID Numbers: new valley anesthesia g2

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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