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Do peripheral nerve blocks work shorter if you are on opioids?
Background:
Peripheral nerve blocks effectively alleviate postoperative pain. Animal studies and human research indicate that opioid tolerance results in reduced effectiveness of local analgesics. This applies to both central nerve blockade and infiltration anaesthesia. The impact on peripheral nerve block in humans has not been evaluated. The aim of the study is to assess the onset time and duration of a radial nerve block in opioid tolerant individuals compared to opioid naive individuals. We hypothesise that peripheral nerve blocks cause shorter sensory and motor block in opioid-tolerant compared to opioid-naive counterparts.
Methods:
Twenty opioid-tolerant individuals will be matched by sex and age with opioid-naïve counterparts. Participants will undergo an ultrasound-guided radial nerve block. The onset time and duration of motor and sensory blockade will be tested and measured. The primary outcome is difference in duration of sensory nerve blockade between the two groups. The secondary outcomes include the onset time of sensory blockade, onset time of motor blockade, and difference in duration of motor nerve blockade.
Perspectives:
The data from this study will provide evidence for the duration of peripheral nerve block in opioid tolerant individuals and support if a specific postoperative protocol for opioid tolerant individuals is needed or it should be of special attention.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Opioid tolerant | Experimental | Daily use of opioid of 60 mg or more |
|
| Opioid naive | Experimental | No use of opioids within the last 30 days |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Radial nerve block | Other | Ultrasound-guided Radial nerve block. Conducted with 10 mL of Lidocaine 2%. Ultrasound image are stored for documentation. |
|
| Measure | Description | Time Frame |
|---|---|---|
| The difference in the duration of sensory block for a radial nerve block between opioid-tolerant and opioid-naive individuals. | Following the injection of local anaesthetic, motor and sensory assessments will be conducted at 30-second intervals until complete sensory and motor blockade, respectively. These assessments will involve comparisons with the contralateral side. Sensory testing will be performed on the dorsal side of the 1. intermetacarpal area (the space between the thumb and the index finger) and the proximal dorsolateral area of the antebrachium. In both areas seeking to explore the boundaries of the innervation area. Dual testing is performed to accommodate interindividual variabilities in dermatomes. Sensation will be evaluated with a monofilament (Touch Test, 60 g; Stoelting, Co, Wood Dale, IL) using a 11-point sensory scale: 5 = extremely intense sensation 0 = normal sensation. -5 = no sensation. | Up to one hour after nerve block placement. |
| Measure | Description | Time Frame |
|---|---|---|
| The difference in the onset time of sensory block from a radial nerve block between opioid-tolerant and opioid-naive individuals. | Following the injection of local anaesthetic, motor and sensory assessments will be conducted at 30-second intervals until complete sensory and motor blockade, respectively. These assessments will involve comparisons with the contralateral side. Sensory testing will be performed on the dorsal side of the 1. intermetacarpal area (the space between the thumb and the index finger) and the proximal dorsolateral area of the antebrachium. In both areas seeking to explore the boundaries of the innervation area. Dual testing is performed to accommodate interindividual variabilities in dermatomes. Sensation will be evaluated with a monofilament (Touch Test, 60 g; Stoelting, Co, Wood Dale, IL) using a 11-point sensory scale: 5 = extremely intense sensation 0 = normal sensation. -5 = no sensation. |
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Inclusion criteria for opioid group
Inclusion criteria for the opioid naive control group
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mikkel SH Jensen, MD | Contact | 20333104 | mikpes@rm.dk | |
| Charlotte Runge, MD | Contact | 78416681 | charlotte.runge@aarhus.rm.dk |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Silkeborg Regional Hospital | Recruiting | Silkeborg | 8600 | Denmark |
all IPD that underlie results in a publication
Within one year of the end of the trial.
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A volunteer blinded matched case-control study.
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An investigator blinded to the volunteer's opioid status will perform all the sensory and motor tests after thorough instruction in this procedure. Only the primary investigator will have the knowledge of opioid status.
| Up to one hour after nerve block placement. |
| The difference in the onset time of motor block from a radial nerve block between opioid-tolerant and opioid-naive individuals. | Following the injection of local anaesthetic, motor and sensory assessments will be conducted at 30-second intervals until complete sensory and motor blockade, respectively. These assessments will involve comparisons with the contralateral side. With the arm placed in pronated position on a flat and solid surface the ability to dorsally flex the wrist is used to evaluate motor block on a Modified Bromage three-point scale: 0 = normal contraction.
| Up to one hour after nerve block placement. |
| The difference in the duration of motor block for a radial nerve block between opioid-tolerant and opioid-naive individuals. | Following the injection of local anaesthetic, motor and sensory assessments will be conducted at 30-second intervals until complete sensory and motor blockade, respectively. These assessments will involve comparisons with the contralateral side. With the arm placed in pronated position on a flat and solid surface the ability to dorsally flex the wrist is used to evaluate motor block on a Modified Bromage three-point scale: 0 = normal contraction.
| Up to one hour after nerve block placement. |