Costoclavicular vs Paracoracoid Approach to Infraclavicular Brachial Plexus Block: a Feasibility Study (CPI)

Lawson Health Research Institute

Status: Completed

Conditions: Upper Limb Injury

Treatments: Device: Ultrasound; Drug: Ropivacaine

Study type: Interventional

Funder types: Other

Identifiers

NCT02657291

LawsonHRI

Details and patient eligibility

About

Patients for upper limb surgeries who are candidates for infraclavicular block will be screened. Two techniques of infraclavicular block will be compared. Measured outcomes are performance times, block onset times, patient satisfaction, quality of block, and requirement for supplementary analgesia.

Full description

Infraclavicular brachial plexus block under ultrasound guidance is used for surgeries on the upper limb. Traditionally, the block is performed at the lateral infraclavicular fossa where the cords are variable in position relative to the axillary artery. A recently introduced technique is the costoclavicular approach where the cords are viewed as relatively more superficial and clustered together compared to the traditional technique. Those meeting the inclusion criteria and will consent to participate in the study will be randomized to have either an infraclavicular block in the paracoracoid approach (Group 1) or an infraclavicular block in the costoclavicular approach (Group 2). All groups will have the same injectable volume (35 mls) and local anesthetic concentration (ropivacaine 0.5%). There will be 35 study patients for each group for a total of 70 patients.

Enrollment: 70 patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Ambulatory elective surgery of the upper limb
• ASA (American Society of Anesthesiologists physical status classification system) 1-4
• Suitable for procedure to be carried out under infraclavicular block

Exclusion criteria

• Inability to give informed consent, Allergy to local anesthetics, morphine or fentanyl
• Ongoing major medical or psychiatric problems
• Narcotic abuse
• Peripheral neuropathy or major neurological problems
• Scarring in area of blockade
• Inability to co-operate with post-operative evaluation
• Major coagulopathy
• Pregnancy and breast-feeding
• Women of childbearing age who are not taking adequate contraceptive precautions

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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70 participants in 2 patient groups

Costoclavicular

Experimental group

Description:

Ultrasound-guided infraclavicular block using Ropivacaine 0.5% 35 mL using the costoclavicular approach

Treatment:

Drug: Ropivacaine

Device: Ultrasound

Paracoracoid

Active Comparator group

Description:

Ultrasound-guided infraclavicular block using Ropivacaine 0.5% 35 mL using the paracoracoid or standard approach

Treatment:

Drug: Ropivacaine

Device: Ultrasound