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The investigators compared the postoperative analgesia of nerve stimulator-guided and ultrasound-guided infraclavicular block for upper extremity surgery.
Ultrasound (US)-guided peripheral nerve block has increased in popularity. It has many advantages such as improved success rate, faster onset time, fewer needle passes, shorter performance time, and reduced procedural pain and vascular puncture. However, there is no information about postoperative analgesia.
Therefore, the investigators tested whether ultrasound-guided peripheral nerve block enhanced the postoperative analgesia for upper extremity surgery compared with nerve stimulator (NS) guidance.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| NS-guided infraclavicular block | Active Comparator | NS-guided infraclavicular block is performed using 35 ml of 0.5% ropivacaine. |
|
| US-guided infraclavicular block | Experimental | US-guided infraclavicular block is performed using 35 ml of 0.5% ropivacaine. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| NS-guided infraclavicular block | Procedure | Patients received a standard single injection infraclavicular block using the lateral sagittal approach of Klaastad. The infraclavicular brachial plexus is identified using an insulated needle connected to a nerve stimulator. Placement of the needle is considered adequate if motor response of radial nerve in the hand or wrist is still present at 0.2 - 0.5mA. Ropivacaine 0.5% 35ml is used. |
| Measure | Description | Time Frame |
|---|---|---|
| Duration of postoperative analgesia | time from completion of local anesthetic injection until the first request for an analgesic | at 24h after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| block performance time | the time between the block needle insertion and needle withdrawal | at 30 min after block placement |
| number of needle redirections | either forward or backward movement of needle at least 1 cm or more |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Chunwoo Yang, MD | Dept. of anesthesia and pain medicine, Cheju Halla General Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cheju Halla General Hopsital | Jeju City | Jeju Self-governing Province | 670-744 | South Korea |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25376973 | Background | Choi S, McCartney CJ. Evidence Base for the Use of Ultrasound for Upper Extremity Blocks: 2014 Update. Reg Anesth Pain Med. 2016 Mar-Apr;41(2):242-50. doi: 10.1097/AAP.0000000000000155. | |
| 18477070 | Background | Koscielniak-Nielsen ZJ. Ultrasound-guided peripheral nerve blocks: what are the benefits? Acta Anaesthesiol Scand. 2008 Jul;52(6):727-37. doi: 10.1111/j.1399-6576.2008.01666.x. Epub 2008 May 12. |
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| ID | Term |
|---|---|
| D010146 | Pain |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| US-guided infraclavicular block | Procedure | Infraclavicular block is performed under ultrasound guidance. Linear probe is placed in a parasagittal positon below the clavicle medial to the coracoid process and adjusted to achieve a cross-sectional image of the axillary artery. Using in-plane technique, an 22-gauge insulated needle is advanced caudally and posteriorly to the axillary artery. Subsequently, 35 ml of 0.5% ropivacaine is incrementally injected. |
|
| at 30 min after block placement |
| patient discomfort | pain score (0-10) during the procedure | at 30 min after block placement |
| paresthesia | presence of paresthesia during the procedure | at 30 min after block placement |
| onset time | complete block of sensory nerve (radial, ulnar, median, musculocutaneous, and medial antebrachial cutaneous nerve) | until 30min after completion of local anesthetic |
| motor block of hand | presence of motor block in the operated hand | at 24h after surgery |
| postoperative dysesthesia | presence of any paresthesia in the operated extremity | at 24h after surgery |
| supplemental analgesia | Rescue analgesia with 75 mg of IM diclofenac was available on demand. | at 24h after surgery |
| Pain score | at 24h after surgery |
| Patient satisfaction | The acceptance of the anesthetic technique was evaluated using a two-point score: 1, satisfactory (if necessary, I would have the same anesthetic technique); and 2, unsatisfactory (different anesthetic technique). | at 24h after surgery |