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The purpose of this study is to compare the analgesic outcomes (time to first analgesic request, total amount of analgesic consumption, and pain scores) following the ultrasound-guided retroclavicular infraclavicular approach and the axillary approach in obese patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group (R) | Active Comparator | Patients will recieve retroclavicular infraclavicular brachial plexus block |
|
| Group (A) | Active Comparator | Patients will receive the axillary brachial plexus |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| retroclavicular infraclavicular brachial plexus block for | Other | The patient will be placed supine, head facing the contralateral side. A high- frequency 13-6 MHz linear array transducer probe will be placed medial to the coracoid process below and perpendicular to the clavicle to obtain a short-axis view of the cords of the brachial plexus and the axillary vessels. The needle will be inserted in the supraclavicular fossa, approximately one cm posteriorly to the clavicle, and advanced in plane parallel to the probe. After passing the initial blind zone of about 2 cm caused by the clavicle's acoustic shadow, the needle tip will be continuously seen, until it appears posterior to the axillary artery. A single injection of the local an esthetic will be performed without needle repositioning unless paresthesia is elicited |
| Measure | Description | Time Frame |
|---|---|---|
| Time to first analgesic request in each group | 24 hours postoperative |
| Measure | Description | Time Frame |
|---|---|---|
| Block assessment and definition of successful block | 30 minutes after the block | |
| Imaging time | the time between probe application and insertion of the needle | |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Howida A Kamal, MD | faculty of medicine,zagazig university Egypt | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| faculty of medicine,zagazig university Egypt | Zagazig | 44519 | Egypt |
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| axillary block | Other | The axillary nerve block is performed from behind the patient with the patient seated. The axillary nerve will be identified within the quadrilateral space by placing high frequency linear probe parallel to the long axis of the humeral shaft. The nerve was identified next to the circumflex artery |
|
| Needle time |
| the time between insertion of the needle and complete injection of local anesthetic |
| -Procedure time | the summation of the imaging and needling times |
| Pain intensity | 10-point NRS [(0 = no pain, 10 = worst imaginable pain), 1 - 3: Mild pain (nagging, annoying, slightly interfering with activities of daily living (ADLs), 4 - 6: Moderate pain (significantly interfering with ADLs, 7 - 10: Severe pain (disabling, unable to perform ADLs)] | basal, one, 2, 4, 8, 12, 16, 20 and 24 hours postoperative |
| Total analgesia need | the first postoperative 24 hours |
| Duration of the sensory block | first 24 hours postoperative |
| Duration of the motor block | first 24 hours postoperative |
| Incidence of block complications | hematoma formation or paresthesia or local anesthetic systemic toxicity. | first 24 h0urs postoperative |