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The investigators plan to determine the onset time and incidence of hemidiaphragmatic paresis (HDP) with a double injection supraclavicular nerve block in patients presenting for upper extremity surgery below the elbow.
The hypothesis is HDP following supraclavicular brachial plexus block occurs with-in 15 minutes of block performance and is not associated with subjective dyspnea.
This study will be an observational trial to assess the onset time and incidence of hemidiaphragmatic paresis in patients who undergo the double injection ultrasound-guided supraclavicular block. Diaphragmatic dysfunction will be determined by intercostal diaphragm thickening measured using ultrasound. The available image will be saved.
Patients having below the elbow surgery will be be approached by someone from the research team for consent and possible inclusion in the study. This will be done in the anesthesia preoperative assessment clinic, or in the pre-op area on the day of surgery (if a patient was not seen in clinic).
A baseline ultrasonographic diaphragmatic assessment will be completed. Study participants will then receive supraclavicular brachial plexus block as per standard of care. Ultrasonographic diaphragmatic assessment and dyspnea score (using modified Borg dyspnea scale) will be performed every 5 minutes for 30 minutes, or until the patient is transferred to the operating room, whatever comes first. Patients will also undergo an ultrasonographic diaphragmatic assessment and dyspnea score in the recovery room after their surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Assessment arm | Other |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ultrasonographic diaphragmatic assessment | Diagnostic Test | Diaphragmatic dysfunction will be determined by intercostal diaphragm thickening. The available image will be saved. Diaphragmatic motion assessments will be conducted on the side to be blocked both at baseline, and then every 5 minutes until patient leaves for operating room or 30 minutes (whatever is earlier). |
| Measure | Description | Time Frame |
|---|---|---|
| Frequency of hemi-diaphragmatic paresis | Number of participants in which hemi-diaphragmatic paresis is detected using ultrasound measurement of diaphragmatic thickening | Relative change in ultrasound assessment of diaphragmatic thickening (Baseline vs 30 min after supraclavicular block) |
| Onset time of hemi-diaphragmatic paresis | The average time at which hemi-diaphragmatic paresis is detected using ultrasound measurement of diaphragmatic thickening | Baseline, 5, 10, 15, 20, 25, and 30 minutes after block |
| Measure | Description | Time Frame |
|---|---|---|
| The correlation of subjective dyspnea | Using the modified Borg dyspnea scale ranging from 0 (no breathlessness at all to 10 (maximal breathlessness) | Baseline, 5, 10, 15, 20, 25, and 30 minutes after block |
| Incidence of HDP after surgical procedure under supraclavicular brachial plexus block (in post recovery unit). |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| NSHA | Halifax | Nova Scotia | B3H 2Y9 | Canada |
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|
Based upon sonographic assessment |
| Post-operatively up to 24 hours |