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Forearm SurgeryNCT06027918

The Effect of Altitude Difference on the Duration of Nerve Block; A Three-Center Study.

A study testing Infraclavicular brachial plexus block in people with Forearm Surgery, run by Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital at 1 site in Turkey (Türkiye).

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Infraclavicular brachial plexus block in hand and forearm surgery has the advantages of high success rate and low risk of complications and is useful in providing long-lasting and effective postoperative analgesia in these patients. Read more about this study

Who is it for?
Ages 18 to 55 years
Conditions the study is for
Forearm Surgery
What is being tested?
Infraclavicular brachial plexus block
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
159 participants
Where
1 siteTurkey (Türkiye)
Study dates
3 Oct 2023to 16 Apr 2024
Phase
Interventional
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 55 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Between 18-55 years old
  • Body mass index between 20 and 25
  • Patients with American Society of Anesthesiologists classification (ASA) physical status I or II

Who cannot join

  • Patients aged younger than 18 and older than 55 years
  • American Society of Anesthesiologists classification (ASA) ≥ III
  • Body mass index (BMI) >35
  • Known history of allergy to local anesthetics preoperative chronic pain and therefore long-term analgesic use
  • In case of coagulopathy
  • Have a condition that constitutes a contraindication for the application of the block (local infection, sepsis, local anesthetic medicine allergy; severe neurological, muscular or psychiatric disease, coagulation disorders)
  • With marked cognitive impairment
  • Patients who did not want to participate in the study.

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site
  • Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital

    Diyarbakır, 21070

Other trials in Turkey (Türkiye)

About this study

Official title: The Effect of Altitude Difference on the Duration of Infraclavicular Peripheral Block Applied to Patients With Hand and Forearm Fractures; a Three-center Study in Adults at 100, 675, 1726 Meters

Infraclavicular brachial plexus block in hand and forearm surgery has the advantages of high success rate and low risk of complications and is useful in providing long-lasting and effective postoperative analgesia in these patients. In response to hypoxemia at high altitude, increased blood viscosity, decreased carbon monoxide diffusion capacity, increased cerebral arterial blood flow, decreased blood volume and decreased cardiac output occur. At high altitude, the serum level of local anesthetics may increase due to an increase in their ionized fraction and a decrease in their clearance. In this respect, the pharmacodynamic and pharmacokinetic properties of peripheral nerve blocks may be altered when performed at high altitude. The primary objective of this prospective study was to test the hypothesis that postoperative pain scores are higher in patients undergoing infraclavicular nerve block at high altitude than in patients at low altitude.

This multicenter prospective randomized study will be initiated after approval of the Ethics Committee of Health ScienceUniversity Diyarbakir Gazi Yasargil Training and Research Hospital. Patients will be recruited simultaneously in 3 hospitals, Hatay Training and Research Hospital, Hatay, Turkey (100 m above sea level);Health Science Health Science University Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey (675 m above sea level) and Health Science University Van Regional and Training Research Hospital, Van, Turkey (1726 m above sea level).

Infraclavicular brachial plexus blocks (coracoid approach) will be performed by administering a local anesthetic mixture of 1.5 mg/kg lidocaine 2% + 1 mg/kg bupivacaine 0.5% at the 6 o'clock position of the axillary artery under US guidance.

Read the detailed description

Group V (1726 meter altitude): In the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance.

  • The block will be applied only once, approximately 15-20 minutes before surgery.
  • All patients will undergo electrocardiographic monitoring, oxygen saturation monitoring with pulse oximetry and blood pressure measurement with automatic pneumatic manometer before the application.
  • Intravenous 1mg midazolam and 50 mcg fentanyl will be administered to all patients for premedication before the procedure.
  • The amount of medication to be given to all patients will be prepared as 1.5mg/kg bupivacaine and 1mg/kg lidocaine.
  • The prepared drug will be administered around the axillary artery at the appropriate anatomical location determined under ultrasound guidance.
  • Ultrasound device will be used as a supportive device during the application.
  • The application will be performed by an anesthesiologist with at least 5 years of experience.
  • mode of delivery will be provided face to face and individually
  • The administration will be only once, 20-30 minutes before the surgical procedure, with a dose adjustment of 1.5mg/kg bupivacaine and 1mg/kg lidocaine per kilogram of weight.
  • The application will be made in the preoperative preparation room in the operating room of the hospital where the surgery will be performed.
  • The local anesthetic dose to be used in the application will be calculated according to the weight of the patient. local anesthetics will be prepared by another anesthesiologist in the preoperative preparation room just before the application.
  • In the postoperative period, if the pain intensity (VAS) is <4, 100 mg paracetamol will be administered intravenously, if VAS = 4, 100 mg tramadol will be administered intravenously

Group D (675 meter altitude): In the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5 mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance.

  • The block will be applied only once, approximately 15-20 minutes before surgery.
  • All patients will undergo electrocardiographic monitoring, oxygen saturation monitoring with pulse oximetry and blood pressure measurement with automatic pneumatic manometer before the application.
  • Intravenous 1mg midazolam and 50 mcg fentanyl will be administered to all patients for premedication before the procedure.
  • The amount of medication to be given to all patients will be prepared as 1.5 mg/kg bupivacaine and 1mg/kg lidocaine.
  • The prepared drug will be administered around the axillary artery at the appropriate anatomical location determined under ultrasound guidance.
  • Ultrasound device will be used as a supportive device during the application.
  • The application will be performed by an anesthesiologist with at least 5 years of experience.
  • mode of delivery will be provided face to face and individually
  • The administration will be only once, 20-30 minutes before the surgical procedure, with a dose adjustment of 1.5 mg/kg bupivacaine and 1mg/kg lidocaine per kilogram of weight.
  • The application will be made in the preoperative preparation room in the operating room of the hospital where the surgery will be performed.
  • The local anesthetic dose to be used in the application will be calculated according to the weight of the patient. local anesthetics will be prepared by another anesthesiologist in the preoperative preparation room just before the application.
  • In the postoperative period, if the pain intensity (VAS) is <4, 100 mg paracetamol will be administered intravenously, if VAS = 4, 100 mg tramadol will be administered intravenously

Comparator / control treatment Group H (100 meter altitude): In the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5 mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance.

  • The block will be applied only once, approximately 15-20 minutes before surgery.
  • All patients will undergo electrocardiographic monitoring, oxygen saturation monitoring with pulse oximetry and blood pressure measurement with automatic pneumatic manometer before the application.
  • Intravenous 1mg midazolam and 50 mcg fentanyl will be administered to all patients for premedication before the procedure.
  • The amount of medication to be given to all patients will be prepared as 1.5 mg/kg bupivacaine and 1 mg/kg lidocaine.
  • The prepared drug will be administered around the axillary artery at the appropriate anatomical location determined under ultrasound guidance.
  • Ultrasound device will be used as a supportive device during the application.
  • The application will be performed by an anesthesiologist with at least 5 years of experience.
  • mode of delivery will be provided face to face and individually
  • The administration will be only once, 20-30 minutes before the surgical procedure, with a dose adjustment of 1.5 mg/kg bupivacaine and 1mg/kg lidocaine per kilogram of weight.
  • The application will be made in the preoperative preparation room in the operating room of the hospital where the surgery will be performed.
  • The local anesthetic dose to be used in the application will be calculated according to the weight of the patient. local anesthetics will be prepared by another anesthesiologist in the preoperative preparation room just before the application.
  • In the postoperative period, if the pain intensity (VAS) is <4, 100 mg paracetamol will be administered intravenously, if VAS = 4, 100 mg tramadol will be administered intravenously
Conditions
Forearm Surgery
Being tested
Infraclavicular brachial plexus block

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Infraclavicular brachial plexus blockProcedure or surgery

    In the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance.

Study groups in NCT06027918
Study groupRoleWhat they receive
Group V (1726 meter altitude)Active comparatorIn the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance. The block will be applied only once, approximately 15-20 minutes before surgery.
Receives: Procedure: Infraclavicular brachial plexus block
Group D (675 meter altitude)Active comparatorIn the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance. The block will be applied only once, approximately 15-20 minutes before surgery.
Receives: Procedure: Infraclavicular brachial plexus block
Group H( 100 meter altitude)Active comparatorIn the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance. The block will be applied only once, approximately 15-20 minutes before surgery.
Receives: Procedure: Infraclavicular brachial plexus block

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Visual Analogue Scale (VAS)

    • The visual analog scale (VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between "no pain" and "worst pain."
    • Pain intensity at the site of the operation.

    Measured: will be evaluated at 0, 4th, 8th, 12th, 14th, 16th, 18th, 24th hours postoperatively

Secondary outcomes (5)
  1. total amount of intravenous analgesics consumed

    to be evaluated at the end of 24 hours postoperatively

    Measured: will be evaluated at 0, 4th, 8th, 12th, 14th, 16th, 18th, 24th hours postoperatively

  2. Sensory block start time

    The onset time of sensory block was defined as the time to reach an absence of hot-cold sensation in all 4 nerve distributions after completion of injection of the local anesthetic mixture.

    Sensory block was assessed using the cold test on the dermatomes of the median, ulnar, radial and musculocutaneous nerves. Sensory block was graded on a 3-point scale (0: normal sensation, 1: analgesia [patient can feel touch but not cold], 2: anesthesia [patient cannot even feel touch]).

    Measured: The sensory block will be evaluated approximately 10 minutes after the application. It will be observed up to a maximum of 30 minutes.

  3. sensory block end time

    Sensory block end time: defined as the time when the hot-cold sensation disappears in all 4 nerve distributions after the injection of the local anesthetic mixture is completed.

    Measured: It will be evaluated every hour after the implementation, up to a maximum of 120 hours.

  4. Time to onset of motor block

    Time to onset of motor block, the time from the completion of injection of the local anesthetic mixture until complete motor block develops (in case of bromage : 4).

    Motor block was assessed with the Modified Bromage scale (scale 0: full flexion of the fingers, wrist and elbow; scale 1: full flexion of the fingers and wrist, but no flexion of the elbow); scale 2: full flexion of the fingers, but no flexion of the wrist and elbow; scale 3: complete motor block; no flexion of the fingers, wrist and elbow).

    Measured: Motor block onset time will be assessed every 10 minutes after the intervention until 60 minutes.

  5. Motor block end time

    Motor block was assessed with the Modified Bromage scale (scale 0: full flexion of the fingers, wrist and elbow; scale 1: full flexion of the fingers and wrist, but no flexion of the elbow); scale 2: full flexion of the fingers, but no flexion of the wrist and elbow; scale 3: complete motor block; no flexion of the fingers, wrist and elbow).

    If the bromage is 0, the motor block will be considered as eliminated.

    Measured: It will be evaluated every hour after the implementation, up to a maximum of 120 hours.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Sep 2023
  2. Study start3 Oct 2023
  3. Primary completion15 Apr 2024
  4. Study completion16 Apr 2024

Resources

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 N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
159 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06027918
Sponsor's protocol ID
12.09.2022/266
Status last verified
May 2024
First submitted
29 Aug 2023
Last updated
23 May 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Harmon D, Frizelle HP. Supraclavicular block for day-case anaesthesia at altitude. Anaesthesia. 2001 Feb;56(2):197. doi: 10.1046/j.1365-2044.2001.01870-30.x. No abstract available.

    PubMed 11167511

Questions about this trial

What is this clinical trial studying?

A study testing Infraclavicular brachial plexus block in people with Forearm Surgery, run by Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital at 1 site in Turkey (Türkiye).

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 8 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: finished, as of the sponsor's last update on 23 May 2024. 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 Turkey (Türkiye). 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.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Visual Analogue Scale (VAS) (time frame: will be evaluated at 0, 4th, 8th, 12th, 14th, 16th, 18th, 24th hours postoperatively). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06027918, which also lists 1 linked publication.

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 23 May 2024.

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