Ultrasound-Guided Axillary or Infraclavicular Nerve Block for Upper Limb Surgery

Summary

This study aims to detect differences in onset time of brachial plexus (i.e., arm) anesthesia using two different nerve block techniques.

Using ultrasound guidance, axillary (i.e., at the armpit) and infraclavicular (i.e., below the collarbone) blocks will be performed to patients undergoing upper limb surgery.

The investigators will analyze how long it takes for anesthesia to be adequate for pain-free surgery, thus determine the optimal technique for this kind of surgery.

Conditions

• Upper Extremity
• Orthopedic Surgery
• Trauma
• Forearm Injuries
• Nerve Block

Interventions

DRUG

Midazolam

Procedural sedation before the execution of the block. * 0.03 mg/kg iv bolus

DRUG

Ropivacaine

0.75% (wt/vol) solution, 20 ml perineural injection

DRUG

Fentanyl

50 µg iv bolus prn for pain during surgery, up to 150 µg

PROCEDURE

General anesthesia

General anesthesia will be induced if pain during surgery develops which is intractable with iv fentanyl ≤150 µg.

PROCEDURE

Axillary brachial plexus nerve block

Blocks will be performed under high-resolution real-time ultrasound guidance. Patients will be in the supine position. With the abducted arm flexed 90° at the elbow, the transducer will scan for the axillary artery in its short-axis. Individual nerves will be sought for around the artery. A 22G, 17°-bevel needle will be advanced in-plane to inject aliquots of local anesthetic around each nerve structure up to the prescribed dose.

PROCEDURE

Infraclavicular brachial plexus block

Blocks will be performed under high-resolution real-time ultrasound guidance. Patients will be in the supine position. The linear transducer will be initially positioned between the middle and lateral third of the clavicle, scanning on a parasagittal plane. The axillary artery and veins will then be sought for. We will try to visualize the three cords of the brachial plexus separately, and to inject local anesthetic around each of them. If this is not possible, the needle will be positioned cranially and posteriorly to the artery, and the injection will be made from there. A 20 G, 17°-bevel needle will be used for all blocks.

Sponsors & Collaborators

• University of Parma

  lead OTHER

Principal Investigators

• Guido Fanelli, MD · Section of Anesthesiology and Critical Care, Dept. of Surgical Sciences, University of Parma

• Giorgio Danelli, MD · UO II Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria di Parma

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

80 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2008-05-31

Primary Completion

2009-06-30

Completion

2009-07-31

Countries

• Italy

Study Locations