The Retroclavicular Approach for Regional Anesthesia

Université de Sherbrooke

Status and phase: Completed; Phase 4

Conditions: Describe Novel Approach to Brachial Plexus Anesthesia

Treatments: Procedure: Retroclavicular block

Study type: Interventional

Funder types: Other

Identifiers

NCT01852396

13-020

Details and patient eligibility

About

The goal of this study is to demonstrate that the novel retroclavicular approach is a safe, fast and effective technique for ultrasound-guided brachial plexus anesthesia.

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.

Enrollment: 50 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Elective or Urgent Surgery of the hand, wrist or forearm
• 18 years and older
• Ability to consent
• American Society of Anesthesiologists class 1 to 3

Exclusion criteria

• Infection at the site of infection
• Abnormal anatomy at the site of infection
• Coagulopathy
• Severe Pulmonary Disease
• Preexisting neurological symptom(s) in the operated arm
• Pregnant patients
• Patients weighing less than 50 kg
• Allergy to amide type local anesthetics

Trial design

Primary purpose: Supportive Care

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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50 participants in 1 patient group

Regional anesthesia

Experimental group

Description:

Recruit 50 patient having elbow, forearm, wrist or hand surgery and block brachial plexus using the novel retroclavicular approach

Treatment:

Procedure: Retroclavicular block