An ultrasound-guided infraclavicular block performed with the costoclavicular (CC) approach
      and the lateral sagittal (LS) approach will be compared in patients scheduled for forearm and
      hand surgery.

Lateral Sagittal vs Costoclavicular Approach for Ultrasound-Guided Infraclavicular Block

Anesthesia, Local

Nerve Block

Brachial Plexus Block

The CC approach is a recently introduced infraclavicular approach that targets three cords
      (medial, lateral and posterior) located lateral to the axillary artery in the costoclavicular
      space. Cords in this space are located more superficially than with the classical approach at
      the lateral infraclavicular fossa and are clustered but maintain a consistent anatomical
      relationship with each other.

      Patients will be divided into two groups:

      Group LS: Ultrasound-guided infraclavicular block - lateral sagittal approach (20 ml 0.5%
      bupivacaine)

      Group CC: Ultrasound-guided infraclavicular block - costoclavicular approach (20 ml 0.5%
      bupivacaine)

Lateral Sagittal Approach

Costoclavicular Approach

Lateral Sagittal Versus Costoclavicular Approach for Ultrasound-Guided Infraclavicular Brachial Plexus Block: Comparison of Block Dynamics and Patient Comfort

Time elapsed from when the needle enters the skin after an optimal view is obtained on ultrasound until the block needle exits the skin after the procedure is completed.

Time from when a Lovett score of 5 is seen in at least 1 of 3 cords in the patient extremity on which the operation is being performed, following local anesthetic injection.
Lovett rating scale: 6 = normal muscle strength, 5 = slightly decreased muscle strength, 4 = significantly decreased muscle strength, 3 = slight loss of movement, 2 = significant loss of movement, 1 = near total loss of movement, and 0 = total paralysis.
Motor block cord myotomes will be evaluated as medial cord (thumb adduction = ulnar nerve), lateral cord (elbow flexion = mucocutaneous nerve), and posterior cord (wrist extension = radial nerve).

Time from the local injection to when a pin-prick test yields no response in at least 1 of 3 cords in the extremity on which the operation is being performed.

Assistant Professor

Time when the patient describes pain or when the pin-prick test yields a positive response in the extremity on which the operation is performed.

Time when Lovett score is 2 at any of the 3 dermatomes of the extremity on which the operation is being performed.
Lovett rating scale 6 = normal muscle strength, 5 = slightly decreased muscle strength, 4 = significantly decreased muscle strength, 3 = slight loss of movement, 2 = significant loss of movement, 1 = near total loss of movement, and 0= total paralysis.
Motor block cord myotomes will be evaluated as medial cord (thumb adduction=ulnar nerve), lateral cord (elbow flexion= mucocutaneous nerve), and posterior cord (wrist extension=radial nerve).

The discomfort produced by the procedure will be evaluated using the visual rating scale (VRS) at the end of the operation day.
VRS: 0-100, 0 = no discomfort at all, 100 = excessive discomfort.

Surgeon satisfaction will be evaluated at the end of the operation day using the VRS.
VRS: 0-100, 0 = no discomfort at all, 100 = excessive discomfort.

Number of needle redirections until target area is reached: number of attempts to withdraw and redirect the needle without total withdrawal from the skin.

Number of needle attempts required until target area is reached: number of withdrawals and redirections of the needle with total withdrawal from the skin.

Patients subjected to an additional rescue block due to positivity in a pin-prick test at a sensorial examination 45 minutes after the block procedure; these patients will be recorded.

Time at which the first analgesic is requested.

Ultrasound-guided infraclavicular block - lateral sagittal approach (20 ml 0.5% bupivacaine)

Ultrasound-guided infraclavicular block - costoclavicular approach (20 ml 0.5% bupivacaine)

Lateral Sagittal vs Costoclavicular Approach for Ultrasound-Guided Infraclavicular Block

About this trial

Study ID

Status

Type

Phase

Placebo

Accepting

Trial Timing

What is this trial about?

What are the participation requirements?

Locations

Location

Status