The effectiveness of additional thoracic paravertebral block in improving the anesthetic effects of regional anesthesia for proximal humeral fracture surgery in elderly patients: study protocol for a randomized controlled trial

Xiaofeng Wang, Hui Zhang, Zhenwei Xie, Qingfu Zhang, Wei Jiang, Junfeng Zhang, Xiaofeng Wang, Hui Zhang, Zhenwei Xie, Qingfu Zhang, Wei Jiang, Junfeng Zhang

Abstract

Background: The innervation of the shoulder-upper-extremity area is complicated and unclear. Regional anesthesia with a brachial plexus and cervical plexus block is probably inadequate for the proximal humeral surgery. Missing blockade of the T1-T2 nerves may be the reason. We conduct this prospective randomized controlled trial (RCT) to explore whether an additional T2 thoracic paravertebral block (TPVB) can improve the success rate of regional anesthesia for elderly patients in proximal humeral fracture surgery.

Methods/design: The patients aged 65 years or older, referred for anterior-approach proximal humeral fracture surgery, will be enrolled. Each patient will be randomly assigned 1:1 to receive a combined interscalene brachial plexus with superficial cervical plexus block (IC) (combined interscalene brachial plexus with superficial cervical plexus block) or an IC block combined with thoracic paravertebral block (ICTP) block (combined thoracic paravertebral block with brachial plexus and superficial cervical plexus block). The primary outcome is the success rate of regional anesthesia without rescue analgesic methods. The secondary outcomes are as follows: sensory block at the surgical area, proportion of patients who need rescue anesthesia (intravenously administered remifentanil or conversion to general anesthesia), cumulative doses of intraoperative vasoactive medications and adverse events. The total sample size is estimated to be 80 patients.

Discussion: This RCT aims to confirm whether an additional T2 TPVB can provide better anesthetic effects of regional anesthesia with brachial and cervical plexus block in elderly patients undergoing proximal humeral surgery.

Trial registration: ClinicalTrials.gov, ID: NCT03919422. Registered on 19 April 2019.

Keywords: Brachial plexus block; Cervical plexus block; Elderly; Intercostobrachial nerve; Proximal humeral fracture; Regional anesthesia; Thoracic paravertebral block.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) recommended content for the schedule of enrollment, interventions and assessments
Fig. 2
Fig. 2
Flowchart of trial procedures
Fig. 3
Fig. 3
Ultrasound image of the thoracic paravertebral block (TPVB). TPS thoracic paravertebral space, TP transverse process, SP spinous process, P pleura, L lung, IM intercostal muscle, RM rhomboid muscle, ESM erector spinae muscles, T trapezius

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