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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 subcoracoid tunnel block or costoclavicular block for elderly patients undergoing distal upper limb surgeries.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group (S) | Active Comparator | The patient will receive subcoracoid tunnel block |
|
| Group (C) | Active Comparator | The patient will receive costoclavicular block |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| subcoracoid tunnel block | Other | The probe will be placed with its proximal end towards the mid-clavicular point and distal end with a marker towards the apex of the axilla. A medial tilt of the probe will demonstrate the posterior and medial cords, while a slight lateral tilt of the probe will demonstrate the lateral cord. The needle entry point at the distal end of the probe will be marked. By using the in-plane technique, the needle will be advanced from a caudal to cephalad direction. The probe will be tilted medially, and the needle will be advanced to position its tip above the posterior or medial cord. The probe will be tilted laterally. The needle tip will be repositioned above the lateral cord, and the LA will be injected |
| Measure | Description | Time Frame |
|---|---|---|
| the onset time of sensory block | the time interval between the end of total local anesthetic administration and complete sensory block | 5 minutes after the block |
| Measure | Description | Time Frame |
|---|---|---|
| block performance time | time of performance of the block | |
| 3. Time of first rescue analgesia(naluphine) | 24 hours postoperative | |
| Pain intensity |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Marwa M Medhat, MD | Contact | 01002828937 | medhatmarwa9@gmail.com | |
| Howida A Kamal, MD | Contact | 01225096755 | K.Howida@yahoO.com |
| 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 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39835953 | Background | Kaya S, Sahap M, Demirtas K. Comparison of costoclavicular and lateral sagittal infraclavicular approaches in ultrasound-guided brachial plexus block. Agri. 2025 Jan;37(1):32-41. doi: 10.14744/agri.2024.34022. |
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| Costoclavicular block | Other | . The key anatomical structures will be identified under ultrasound: the pectoralis major muscle, subclavius muscle, and three brachial plexus cords (lateral, medial, and posterior) clustered tightly lateral to the axillary artery, along with the axillary artery and vein. The needle will be inserted by the in-plane technique from lateral to medial. The needle tip will be advanced through subcutaneous tissue and subclavius, aiming to land in the costoclavicular fascial plane between the cords, ideally between the lateral and posterior cords and superficial to the medial cord, without traversing neural structure by multipoint strategy, and local anesthesia will be injected. |
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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, 18, 24, and 24 hours postoperative |
| patient's satisfaction | The patients will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia) | 24 hours postoperative |
| Incidence of block complications | hematoma formation or paresthesia or local anesthetic systemic toxicity. | first 24 hours postoperative |