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Patients undergoing hand, wrist, and elbow surgery may experience pain after surgery. The orthopedic surgeon may provide prescription pain medications after surgery to assist with pain control. However, with concern of the opioid epidemic, many patients would rather minimize the use of narcotic pain prescriptions after having surgery. As an alternative, ultrasound guided regional nerve blocks can assist with postoperative pain control.
patients consented to this study will be randomized into three groups: 1) will receive an ultrasound guided nerve block with local anesthesia only, 2) will receive an ultrasound guided nerve block with local anesthesia and a steroid dexamethasone, 3) will receive an ultrasound guided nerve block with liposomal bupivacaine.
our study team will make phone calls after surgery to the patient to determine how long the block lasted for, and how many opioid pain pills were taken up to 3 days after surgery.
Our study team predicts that the ultrasound guided nerve block with liposomal bupivacaine can last approximately 48 hours, while the block with local anesthesia and dexamethasone will last approximately 30 hours, and the block with local anesthesia only may last up to 24 hours
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control Arm: local anesthesia only in ultrasound guided supraclavicular nerve block | No Intervention | ultrasound guided supraclavicular nerve blocks are typically performed with the use of local anesthesia only | |
| Study Arm: local anesthesia with perineural dexamethasone | Experimental | dexamethasone is a potent steroid that when provided in ultrasound guided nerve blocks can extend the duration of the nerve block. |
|
| Study Arm: liposomal bupivacaine | Experimental | our study team would like to determine how use of liposomal bupivacaine in supraclavicular nerve blocks can lengthen the duration of the nerve block, and how it may affect the number of opioid pills used after surgery up until postoperative day three. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Liposomal bupivacaine (LB) | Drug | our study team wishes to determine effect of liposomal bupivacaine in regional nerve blocks for surgery of the upper extremity (finger, hand, wrist, elbow) |
| Measure | Description | Time Frame |
|---|---|---|
| Subjective length of duration of block | our study team contacts the patients 4 days after surgery to ask how long their regional nerve block lasted | feedback obtained up until day 3 after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Number of opioid pills taken until postoperative day 3 | our study team contacts the patients to ask how many opioid pain pills were taken from arrival to home up until postoperative day 3 | feedback until day 3 after surgery |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Anna Ng-Pellegrino, MD | St. Luke's Hospital and Health Network, Pennsylvania | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| St. Luke's University Health Network | Bethlehem | Pennsylvania | 18015 | United States |
we will provide results on our measured outcomes: subjective length of duration of block, number of opioid pills taken by postsurgical day 3. we will provide de-identified information on demographics as well between the control arm and treatment arms
we will provide deidentified data on patients participating within the start to end dates of patient recruitment. This data will be available to view in anticipated publication to a journal
This information can be available to view after publication to a journal.
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randomization into three groups. Control group is administration of local anesthesia in ultrasound guided supraclavicular nerve blocks. There are two study groups. The intermediate study group is administration of local anesthesia with dexamethasone in the ultrasound guided supraclavicular nerve block. The other study group is administration of liposomal bupivacaine in the ultrasound guided supraclavicular nerve block.
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the patient is blinded to the study arm
|
| Dexamethasone | Drug | dexamethasone injected in perineural area can extend the regional nerve block |
|
|
| ID | Term |
|---|---|
| D004387 | Dupuytren Contracture |
| D000092503 | Wrist Fractures |
| ID | Term |
|---|---|
| D005350 | Fibroma |
| D018218 | Neoplasms, Fibrous Tissue |
| D009372 | Neoplasms, Connective Tissue |
| D018204 | Neoplasms, Connective and Soft Tissue |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D003286 | Contracture |
| D009135 | Muscular Diseases |
| D009140 | Musculoskeletal Diseases |
| D003240 | Connective Tissue Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D014954 | Wrist Injuries |
| D001134 | Arm Injuries |
| D014947 | Wounds and Injuries |
| D050723 | Fractures, Bone |
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| ID | Term |
|---|---|
| D003907 | Dexamethasone |
| ID | Term |
|---|---|
| D011246 | Pregnadienetriols |
| D011245 | Pregnadienes |
| D011278 | Pregnanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
| D013259 | Steroids, Fluorinated |
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