Axillary Block in Association With Analgesic Truncal Blocks at the Elbow for Wrist Surgery. (BAXASSO)

CMC Ambroise Paré

Status: Completed

Conditions: Wrist Fracture

Treatments: Procedure: Axillary brachial plexus block with a long-acting local anesthetic; Drug: Lidocaine; Drug: Ropivacaine; Procedure: Axillary brachial plexus block with a short-acting local anesthetic + Analgesic block at the elbow with a long-acting local anesthetic

Study type: Interventional

Funder types: Other

Identifiers

NCT04046744

2019/03

Details and patient eligibility

About

Fractures of the forearm bones that occur around the wrist are common in the elderly. Standard anesthesia for its surgical treatment is regional anesthesia (RA): supraclavicular block, infraclavicular block or axillary block (BAX). However, these techniques have some limitations, such as the postoperative pain management and the non-specificity of the analgesia. Indeed analgesia is not specific to the wrist and extends to the elbow and forearm, preventing rapid recovery of elbow flexion and extension when a long-acting local anesthetic (LA) is used. Recently RA techniques associating proximal anesthetic blocks with distal analgesic blocks have been proposed to serve a dual objective: good anesthesia for surgery and specific analgesia.

The hypothesis of this study is that, for the wrist surgery, axillary block using a short-acting LA combined with analgesic blocks at the elbow using a long-acting LA could provide a RA installation time reduction, an optimal surgical comfort, a longer post-operative analgesia duration and a faster recovery from motor block.

Full description

This multicenter, prospective, randomized, open-Label study compares two techniques :

• BAX (usual technique) : Axillary brachial plexus block (Axillary block) with a long-acting LA (Ropivacaine)
• BAX-Asso (experimental technique) : Axillary brachial plexus block (Axillary block) with a short-acting local anesthetic (Lidocaine) + Analgesic block at the elbow with a long-acting local anesthetic (Ropivacaine) Every block will be performed under Ultrasound. BAX will be performed using a multi-injection technique at contact with median (nM), radial (nR), ulnar (nU), musculocutaneous (nMC) and medial antebrachial cutaneous (nCMAB) nerves. 15-30 mL of LA will be injected.

Analgesic truncal blocks of the median and radial nerves will be performed at the elbow. 3-7 mL of LA will be injected.

Enrollment: 150 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients undergoing wrist fracture surgery under regional anesthesia
• Consent for participation
• Affiliation to the French social security system

Exclusion criteria

• Chronic use of opiod analgesics
• Chronic pain syndrome or fibromyalgia
• Contraindication for locoregional anesthesia
• Contraindication for opioid
• ASA IV
• Pregnant or breastfeeding women
• Patients under protection of the adults (guardianship, curators or safeguard of justice)
• Communication difficulties or neuropsychiatric disorder

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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150 participants in 2 patient groups

BAX

Active Comparator group

Treatment:

Drug: Ropivacaine

Procedure: Axillary brachial plexus block with a long-acting local anesthetic

Drug: Ropivacaine

BAX-Asso

Experimental group

Treatment:

Drug: Ropivacaine

Procedure: Axillary brachial plexus block with a short-acting local anesthetic + Analgesic block at the elbow with a long-acting local anesthetic

Drug: Lidocaine

Drug: Ropivacaine