Regional Anesthesia MorbidityPhase 4NCT03188939
Comparative Study Between Single , Intra- Cluster and Double-injection Ultrasound-guided Supraclavicular Block of Brachial Plexus
A Phase 4 study testing single injection supraclavicular brachial pleuxus block, intracluster injection supraclavicular brachial pieuxus block and double injection supraclavicular brachial pleuxus block in people with Regional Anesthesia Morbidity, run by Cairo University at 1 site in Egypt.
Trial summary
Supraclavicular block of brachial plexus is a type of regional anesthesia sometimes employed as an alternative to general anesthesia for surgery of the forearm. Many approaches have been described for ultrasound-guided supraclavicular block of the brachial plexus , Double- injection technique , single-injection and… Read more about this study
- Who is it for?
- Ages 18 to 60 years
- Conditions the study is for
- Regional Anesthesia Morbidity
- What is being tested?
- single injection supraclavicular brachial pleuxus block, intracluster injection supraclavicular brachial pieuxus block and double injection supraclavicular brachial pleuxus block
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 36 participants
- Where
- 1 siteEgypt
- Study dates
- Jul 2017to Sep 2017
- Phase
- Phase 4
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 60 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Age ( 18 -60 years)
- ASA l \& ASA II
- Body mass index(20-35 Kg/m2)
Who cannot join
- Pre-existing neuropathy
- ASA lll \& ASA lV
- Previous operation in supraclavicular fossa
- Coagulopathy
- Allergy to local anesthetic
- Pregnancy
- Inability to visualize the brachial plexus during ultrasound scanning.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Randomized Comparative Study Between Single-injection , Intra- Cluster -Injection and Double-injection Ultrasound-guided Supraclavicular Block of Brachial Plexus
Supraclavicular block of brachial plexus is a type of regional anesthesia sometimes employed as an alternative to general anesthesia for surgery of the forearm. Many approaches have been described for ultrasound-guided supraclavicular block of the brachial plexus , Double- injection technique , single-injection and intra- cluster-injection technique. In intra- cluster-injection technique.The comparison between the 3 techniques may allow detecting the most beneficial one. the investigators hypothesized that intra-cluster-injection technique will be associated with more rapid onset, longer duration and the least complications. (because the trunks and divisions of the brachial plexus are relatively close as they travel over the first rib, the onset and quality of anesthesia will be faster and complete) Methods : This study will be conducted at kasr al ainy Hospital Cairo university After obtaining ethics committee approval and written informed consent 36 patients (who will undergo surgery for forearm)included in the study classified into three groups Gs single injection technique ,Gic intra- cluster injection technique, Gd double injection technique After block will be done, a second investigator will examine the patient for sensory and motor block (every 10 minutes for 30 minutes) and for occurrence of complications. The patient will be ready for surgery when the score ≥14 point. At this point the onset will be determined and so the patient can be transferred to the operating room .
If the patient experienced anxiety, propofol infusion (80-250 ug/kg/min) can be started. If the patient experienced pain during surgery the block considered failed and induction of general anesthesia should be started.
After end of the surgery the second investigator will continue to assess the patient for post operative pain every one hour for 24 hours to determine duration of the block.
Read the detailed description
The purpose of this study to compare between three techniques( single- injection, intra-cluster -injection and double-injection) ultrasound-guided supraclavicular block of brachial plexus for surgery of forearm regarding onset of the block , duration, time of performance and possible complications
Study population \& Sample size : 36 patients undergoing elective forearm surgeries in Kasr AL Aini Hospital will be included in the study , patients will be allocated in three groups 12 patient each.
Study Design : randomized comparative study , randomization will be done through closed opaque envelope
Methods :This study will be conducted at kasr al ainy Hospital Cairo university After obtaining ethics committee approval and written informed consent 36 patients (who will undergo surgery for forearm)included in the study classified into three groups Gs single injection technique ,Gic intra- cluster injection technique, Gd double injection technique For the 3 techniques , the investigator will prepare 20 gauge 10cm block needle and portable ultrasound machine (Siemens ACUSON X300 Ultrasound System with linear probe 8-14 MHZ).
In the preparation room, Standard monitors will be connected ,IV peripheral cannula will be inserted in upper limb contra lateral to surgical site and sedative e.g. midazolam 0.02mg/kg will be given. Patient will be positioned semi-sitting, the transducer is positioned in the transverse plane immediately superior to the clavicle at approximately its midpoint. Using a 3-cm, 27-gauge needle, 2 mL of local anesthetic is injected into the skin 1 cm lateral. In single-injection technique using in plane method and lateral to medial direction, local anesthetic (30 ml bupivacaine) is injected at the point where the subclavian artery meets the first rib. In intra- cluster-injection technique using in plane method and lateral to medial direction , the local anesthetic(30 ml bupivacaine) is injected inside main and satellite neural cluster.( Circumferential administration of local anesthetic rather than creating a single point injection ).
In double-injection technique using in plane method and lateral to medial direction half the volume of local anesthetic(15 ml bupivacaine) is injected at intersection of first rib and subclavian artery and another half(15 ml bupivacaine) is injected supero- lateral to subclavian artery to assure spread of the local anesthetic solution in all planes containing brachial plexus. the performance time will be recorded.
After block will be done, second investigator will examine the patient for sensory and motor block (every 10 minutes for 30 minutes) and for occurrence of complications. The patient will be ready for surgery when the score ≥14 point. At this point the onset will be determined and so the patient can be transferred to the operating room .
If the patient experienced anxiety, propofol infusion (80-250 ug/kg/min) can be started. If the patient experienced pain during surgery the block considered failed and induction of general anesthesia should be started.
After end of the surgery the second investigator will continue to assess the patient for post operative pain every one hour for 24 hours to determine duration of the block.
Possible Risks to study population : 1. Intravascular injection of local anaesthetic (if tip of needle is seen under ultrasound screen and the investigator is injecting local anaesthetic but nothing seen under ultrasound screen(tellet sign)) 2. Pneumothorax (asses pleura of the same side by chest x-ray after 6 hours) 3. Intraneural injection (keep an image or video of technique and seek for another opnion) Various studies demonstrated that if intraneural puncture occured the needle usually took a path away from the fascicles (intraneural perifascicular), while intraneural transfascicular puncture seemed relatively rare and intraneural intrafascicular placement of the needle even more uncommon. As long as the needle is placed intraneurally but in an extrafascicular fashion a safe injection and the absence of neurologic damage can be assumed.
- Horner's syndrome (ptosis ,miosis ,anhydrosis may be due to involvement of cervical sympathetic plexus)
- Conditions
- Regional Anesthesia Morbidity
- Being tested
- single injection supraclavicular brachial pleuxus block, intracluster injection supraclavicular brachial pieuxus block, double injection supraclavicular brachial pleuxus block
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
single injection supraclavicular brachial pleuxus blockProcedure or surgery
the investigator will prepare 20 gauge 10cm block needle and portable ultrasound machine , In single-injection technique using in plane method and lateral to medial direction, local anesthetic is injected at the point where the subclavian artery meets the first rib.
intracluster injection supraclavicular brachial pieuxus blockProcedure or surgery
the investigator will prepare 20 gauge 10cm block needle and portable ultrasound machine (Siemens ACUSON X300 Ultrasound System with linear probe 8-14 MHZ).using in plane method and lateral to medial direction , the local anesthetic(30 ml bupivacaine) is injected inside main and satellite neural cluster.( Circumferential administration of local anesthetic rather than creating a single point injection )
double injection supraclavicular brachial pleuxus blockProcedure or surgery
the investigator will prepare 20 gauge 10cm block needle and portable ultrasound machine (Siemens ACUSON X300 Ultrasound System with linear probe 8-14 MHZ).using in plane method and lateral to medial direction , half the volume of local anesthetic(15 ml bupivacaine) is injected at intersection of first rib and subclavian artery and another half(15 ml bupivacaine) is injected supero- lateral to subclavian artery to assure spread of the local anesthetic solution in all planes containing brachial plexus
| Study group | Role | What they receive |
|---|---|---|
| G s | Active comparator | 20 guage 10cm block needle inserted in the supraclavicular fossa guided by portable ultrasound machine using in plane method and lateral to medial direction, local anesthetic (30 ml bupivacaine) is injected at the point where the subclavian artery meets the first rib Receives: Procedure: single injection supraclavicular brachial pleuxus block |
| G ic | Active comparator | 20 guage 10cm block needle inserted in the supraclavicular fossa guided by portable ultrasound machine using in plane method and lateral to medial direction,the local anesthetic(30 ml bupivacaine) is injected inside main and satellite neural cluster.( Circumferential administration of local anesthetic rather than creating a single point injection ) Receives: Procedure: intracluster injection supraclavicular brachial pieuxus block |
| G d | Active comparator | 20 guage 10cm block needle inserted in the supraclavicular fossa guided by portable ultrasound machine using in plane method and lateral to medial direction,half the volume of local anesthetic(15 ml bupivacaine) is injected at intersection of first rib and subclavian artery and another half(15 ml bupivacaine) is injected supero- lateral to subclavian artery to assure spread of the local anesthetic solution in all planes containing brachial plexus Receives: Procedure: double injection supraclavicular brachial pleuxus block |
What is being measured
The primary outcome is the main question the study is designed to answer.
onset of the block onset of anesthesia ( time in minutes from introduction of needle to appearance of 14 point score for motor and sensory block ) onset of the block
time in minutes from introduction of needle to appearance of 14 point score for motor and sensory block )
Measured: from 0- 25 minutes after complete injectio
Secondary outcomes (1)
Duration of the block
from onset to appearance of pain in surgery site
Measured: 25 minutes after injection till 6 hours post oprative
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted16 Jun 2017
- Study startJul 2017 (estimated)
- Primary completionSep 2017 (estimated)
- Study completionSep 2017 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Regional Anesthesia MorbidityStudies of the same condition, open and under way.
- More trials run by Cairo UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 4
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- For the 3 techniques , we will prepare 20 gauge 10cm block needle and portable ultrasound machine , In single-injection technique using in plane method and lateral to medial direction, local anesthetic is injected at the point where the subclavian artery meets the first rib. In intra- cluster-injection technique using in plane method and lateral to medial direction , the local anesthetic is injected inside main and satellite neural cluster. In double-injection technique using in plane method and lateral to medial direction half the volume of local anesthetic is injected at intersection of first rib and subclavian artery and another half is injected supero- lateral to subclavian artery to assure spread of the local anesthetic solution in all planes containing brachial plexus.
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 36 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Cairo University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Sherin Refaat, Cairo University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03188939
- Sponsor's protocol ID
- N-34-2017
- Status last verified
- Jun 2017
- First submitted
- 10 Jun 2017
- Last updated
- 16 Jun 2017
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 16 Jun 2017. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Randomized Comparative Study Between Single-injection , Intra- Cluster -Injection and Double-injection Ultrasound-guided Supraclavicular Block of Brachial Plexus
- ClinicalTrials.gov ID
- NCT03188939
- Acronym / sponsor ID
- N-34-2017
- Conditions
- Regional Anesthesia Morbidity
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 36 participants (estimated)
- Lead sponsor
- Cairo UniversityUniversity, hospital or other
- Study start
- Jul 2017 (estimated)
- Primary completion
- Sep 2017 (estimated)
- Study completion
- Sep 2017 (estimated)
- First posted
- 16 Jun 2017 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Supraclavicular block of brachial plexus is a type of regional anesthesia sometimes employed as an alternative to general anesthesia for surgery of the forearm. Many approaches have been described for ultrasound-guided supraclavicular block of the brachial plexus , Double- injection technique , single-injection and intra- cluster-injection technique. In intra- cluster-injection technique.The comparison between the 3 techniques may allow detecting the most beneficial one. the investigators hypothesized that intra-cluster-injection technique will be associated with more rapid onset, longer duration and the least complications. (because the trunks and divisions of the brachial plexus are relatively close as they travel over the first rib, the onset and quality of anesthesia will be faster and complete) Methods : This study will be conducted at kasr al ainy Hospital Cairo university After obtaining ethics committee approval and written informed consent 36 patients (who will undergo surgery for forearm)included in the study classified into three groups Gs single injection technique ,Gic intra- cluster injection technique, Gd double injection technique After block will be done, a second investigator will examine the patient for sensory and motor block (every 10 minutes for 30 minutes) and for occurrence of complications. The patient will be ready for surgery when the score ≥14 point. At this point the onset will be determined and so the patient can be transferred to the operating room .
If the patient experienced anxiety, propofol infusion (80-250 ug/kg/min) can be started. If the patient experienced pain during surgery the block considered failed and induction of general anesthesia should be started.
After end of the surgery the second investigator will continue to assess the patient for post operative pain every one hour for 24 hours to determine duration of the block.
Detailed description
The purpose of this study to compare between three techniques( single- injection, intra-cluster -injection and double-injection) ultrasound-guided supraclavicular block of brachial plexus for surgery of forearm regarding onset of the block , duration, time of performance and possible complications
Study population \& Sample size : 36 patients undergoing elective forearm surgeries in Kasr AL Aini Hospital will be included in the study , patients will be allocated in three groups 12 patient each.
Study Design : randomized comparative study , randomization will be done through closed opaque envelope
Methods :This study will be conducted at kasr al ainy Hospital Cairo university After obtaining ethics committee approval and written informed consent 36 patients (who will undergo surgery for forearm)included in the study classified into three groups Gs single injection technique ,Gic intra- cluster injection technique, Gd double injection technique For the 3 techniques , the investigator will prepare 20 gauge 10cm block needle and portable ultrasound machine (Siemens ACUSON X300 Ultrasound System with linear probe 8-14 MHZ).
In the preparation room, Standard monitors will be connected ,IV peripheral cannula will be inserted in upper limb contra lateral to surgical site and sedative e.g. midazolam 0.02mg/kg will be given. Patient will be positioned semi-sitting, the transducer is positioned in the transverse plane immediately superior to the clavicle at approximately its midpoint. Using a 3-cm, 27-gauge needle, 2 mL of local anesthetic is injected into the skin 1 cm lateral. In single-injection technique using in plane method and lateral to medial direction, local anesthetic (30 ml bupivacaine) is injected at the point where the subclavian artery meets the first rib. In intra- cluster-injection technique using in plane method and lateral to medial direction , the local anesthetic(30 ml bupivacaine) is injected inside main and satellite neural cluster.( Circumferential administration of local anesthetic rather than creating a single point injection ).
In double-injection technique using in plane method and lateral to medial direction half the volume of local anesthetic(15 ml bupivacaine) is injected at intersection of first rib and subclavian artery and another half(15 ml bupivacaine) is injected supero- lateral to subclavian artery to assure spread of the local anesthetic solution in all planes containing brachial plexus. the performance time will be recorded.
After block will be done, second investigator will examine the patient for sensory and motor block (every 10 minutes for 30 minutes) and for occurrence of complications. The patient will be ready for surgery when the score ≥14 point. At this point the onset will be determined and so the patient can be transferred to the operating room .
If the patient experienced anxiety, propofol infusion (80-250 ug/kg/min) can be started. If the patient experienced pain during surgery the block considered failed and induction of general anesthesia should be started.
After end of the surgery the second investigator will continue to assess the patient for post operative pain every one hour for 24 hours to determine duration of the block.
Possible Risks to study population : 1. Intravascular injection of local anaesthetic (if tip of needle is seen under ultrasound screen and the investigator is injecting local anaesthetic but nothing seen under ultrasound screen(tellet sign)) 2. Pneumothorax (asses pleura of the same side by chest x-ray after 6 hours) 3. Intraneural injection (keep an image or video of technique and seek for another opnion) Various studies demonstrated that if intraneural puncture occured the needle usually took a path away from the fascicles (intraneural perifascicular), while intraneural transfascicular puncture seemed relatively rare and intraneural intrafascicular placement of the needle even more uncommon. As long as the needle is placed intraneurally but in an extrafascicular fashion a safe injection and the absence of neurologic damage can be assumed.
- Horner's syndrome (ptosis ,miosis ,anhydrosis may be due to involvement of cervical sympathetic plexus)
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 3
- Model description
- For the 3 techniques , we will prepare 20 gauge 10cm block needle and portable ultrasound machine , In single-injection technique using in plane method and lateral to medial direction, local anesthetic is injected at the point where the subclavian artery meets the first rib. In intra- cluster-injection technique using in plane method and lateral to medial direction , the local anesthetic is injected inside main and satellite neural cluster. In double-injection technique using in plane method and lateral to medial direction half the volume of local anesthetic is injected at intersection of first rib and subclavian artery and another half is injected supero- lateral to subclavian artery to assure spread of the local anesthetic solution in all planes containing brachial plexus.
| Arm | Type | Receives |
|---|---|---|
| G s | Active comparator | Procedure: single injection supraclavicular brachial pleuxus block20 guage 10cm block needle inserted in the supraclavicular fossa guided by portable ultrasound machine using in plane method and lateral to medial direction, local anesthetic (30 ml bupivacaine) is injected at the point where the subclavian artery meets the first rib |
| G ic | Active comparator | Procedure: intracluster injection supraclavicular brachial pieuxus block20 guage 10cm block needle inserted in the supraclavicular fossa guided by portable ultrasound machine using in plane method and lateral to medial direction,the local anesthetic(30 ml bupivacaine) is injected inside main and satellite neural cluster.( Circumferential administration of local anesthetic rather than creating a single point injection ) |
| G d | Active comparator | Procedure: double injection supraclavicular brachial pleuxus block20 guage 10cm block needle inserted in the supraclavicular fossa guided by portable ultrasound machine using in plane method and lateral to medial direction,half the volume of local anesthetic(15 ml bupivacaine) is injected at intersection of first rib and subclavian artery and another half(15 ml bupivacaine) is injected supero- lateral to subclavian artery to assure spread of the local anesthetic solution in all planes containing brachial plexus |
Who may qualify
- Ages
- 18 to 60 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (3 listed)
- Age ( 18 -60 years)
- ASA l \& ASA II
- Body mass index(20-35 Kg/m2)
Key exclusion criteria (7 listed)
- Pre-existing neuropathy
- ASA lll \& ASA lV
- Previous operation in supraclavicular fossa
- Coagulopathy
- Allergy to local anesthetic
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| single injection supraclavicular brachial pleuxus blockthe investigator will prepare 20 gauge 10cm block needle and portable ultrasound machine , In single-injection technique using in plane method and lateral to medial direction, local anesthetic is injected at the point where the subclavian artery meets the first rib. | Procedure or surgery | G s |
| intracluster injection supraclavicular brachial pieuxus blockthe investigator will prepare 20 gauge 10cm block needle and portable ultrasound machine (Siemens ACUSON X300 Ultrasound System with linear probe 8-14 MHZ).using in plane method and lateral to medial direction , the local anesthetic(30 ml bupivacaine) is injected inside main and satellite neural cluster.( Circumferential administration of local anesthetic rather than creating a single point injection ) | Procedure or surgery | G ic |
| double injection supraclavicular brachial pleuxus blockthe investigator will prepare 20 gauge 10cm block needle and portable ultrasound machine (Siemens ACUSON X300 Ultrasound System with linear probe 8-14 MHZ).using in plane method and lateral to medial direction , half the volume of local anesthetic(15 ml bupivacaine) is injected at intersection of first rib and subclavian artery and another half(15 ml bupivacaine) is injected supero- lateral to subclavian artery to assure spread of the local anesthetic solution in all planes containing brachial plexus | Procedure or surgery | G d |
Primary outcome
onset of the block onset of anesthesia ( time in minutes from introduction of needle to appearance of 14 point score for motor and sensory block ) onset of the block
Time frame: from 0- 25 minutes after complete injectio
time in minutes from introduction of needle to appearance of 14 point score for motor and sensory block )
1 secondary outcome
Duration of the block
Time frame: 25 minutes after injection till 6 hours post oprative
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 16 Jun 2017.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing single injection supraclavicular brachial pleuxus block, intracluster injection supraclavicular brachial pieuxus block and double injection supraclavicular brachial pleuxus block in people with Regional Anesthesia Morbidity, run by Cairo University at 1 site in Egypt.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 16 Jun 2017. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
onset of the block onset of anesthesia ( time in minutes from introduction of needle to appearance of 14 point score for motor and sensory block ) onset of the block (time frame: from 0- 25 minutes after complete injectio). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Jun 2017.