Retroclavicular Approach vs Infraclavicular Approach for Brachial Plexus Block in Obese Patients

Kahramanmaraş Sütçü İmam University (KSU)

Status and phase: Unknown; Phase 4

Conditions: Forearm Injuries; Hand Injuries

Treatments: Drug: Bupivacaine; Other: Ultrasound guided coracoid infraclavicular block; Device: Ultrasound; Other: Ultrasound guided retroclavicular block

Study type: Interventional

Funder types: Other

Identifiers

NCT02990702

31

Details and patient eligibility

About

The retroclavicular approach for brachial plexus anesthesia requires an optimal angle between the needle and the ultrasound beam. Retroclavicular approach has already been proven effective and safe in the past. The general objective is to provide a formal comparison between the retroclavicular approach and coracoid infraclavicular approach for brachial plexus anaesthesia. This study should represent the differences between the two techniques.

Full description

Classic infraclavicular approach of the brachial plexus involves a needle puncture below the clavicle and advancing the needle with a 45-60 degree angle from cephalad to caudad. The aim is to advanced the block needle posterior to the axillary artery and to deposit the local anesthetic at that point, near the posterior cord. A "U" shaped spread around the artery should ensure distribution around all three cords. Ultrasound guidance is highly recommended and neurostimulation is optional.

The retroclavicular approach is a variant to this classical technique. Ultrasound probe is positioned initially below the clavicle in a manner similar to the classic approach but is then rotated in a clockwise fashion (right arm) or counter-clockwise fashion (left arm) for about 25-35 degrees. The puncture site is just behind the clavicle at the most lateral point available. If initial entry point is optimal, needle direction is then parallel to ultrasound probe. The final aim and position of block needle is identical to classical approach. Entry point ensures a parallel alignment of the needle and the ultrasound beam, thus enabling almost perfect visualization of both artery, cords and block needle. This is turn optimizes safety, rapidity of technique, efficiency and efficacy.

It is recognized that regional anesthesia is more difficult to perform in obese patients. Anatomic landmarks are harder to localize in this population and ultrasound guidance is more difficult because of the attenuation of the ultrasound beam by adipose tissue. The complication rate of regional techniques is also reported to be higher in the obese patient population.

Enrollment: 60 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18-80 years
• BMI>30
• Forearm- Hand surgery

Exclusion criteria

• <18 years
• Local infection
• Coagulopaty

Trial design

60 participants in 2 patient groups

Ultrasound guided retroclavicular block

Active Comparator group

Description:

Ultrasound guided retroclavicular block group patients (Group R) will receive 30 cc %0.5 Bupivacaine

Treatment:

Drug: Bupivacaine

Other: Ultrasound guided retroclavicular block

Device: Ultrasound

Other: Ultrasound guided coracoid infraclavicular block

Ultrasound guided infraclavicular block

Active Comparator group

Description:

Ultrasound guided coracoid infraclavicular block group patients (Group C) will receive 30 cc %0.5 Bupivacaine

Treatment:

Drug: Bupivacaine

Other: Ultrasound guided retroclavicular block

Device: Ultrasound

Other: Ultrasound guided coracoid infraclavicular block