Ulnar Nerve Block for Procedural Anesthesia - Wrist Versus Palm

NCT00827658 | Terminated

• 1 other identifier: McMaster 08-053
• Study Type: interventional
• Target: 127
• Locations: 1 country
• Sites: 1

Brief Summary

Ulnar nerve blockade is necessary for sensory anesthesia and analgesia in the hand during minor procedures. The course of the ulnar nerve in the forearm, wrist, and hand is predictable and has low variability. However even with known anatomic location and landmarks, ulnar nerve blocks at the wrist frequently are inadequate for procedural anesthesia. The antebrachial fascia at the wrist acts as a barrier to local infiltration. Since the fascia can not be visualized or palpated, it is commonly not penetrated, resulting in an inadequate block. Furthermore at the level of the wrist the ulnar artery lies in close proximity to the nerve and there is potential for arterial puncture while attempting injection for volar wrist block. The palmar ulnar nerve block is an injection distal to the hook of the hamate in the thenar eminence which avoids the ulnar artery and antebrachial fascia. This block has been used successfully for many years in clinical practice but has not been assessed or compared in a research study. The purpose of this study is to assess the validity of using a palmar ulnar nerve block for procedures in the hand as compared to the standard volar wrist ulnar nerve block.

Conditions

Hand Surgery

Keywords

anesthesia, local; ulnar nerve; hand; surgery, plastic; blinded; randomized; prospective; local anesthesia; volar wrist block; hypothenar palm block; hand surgery

Outcome Measures

Primary Outcomes (1)

• Primary outcome is efficacy of sensory anesthesia and analgesia

  15-45 minutes

Secondary Outcomes (1)

• Secondary outcome is patient perceived discomfort with block

  15-45 Minutes

Study Arms (2)

Hypothenar Palm block

ACTIVE COMPARATOR

Hypothenar Palmar block group. Local anesthetic is placed at this location in this study group. The same local composition (Intervention) is used for both study groups. The trial is a comparison of location not the Intervention.

Procedure: Hypothenar Palm block

Volar Wrist Block

ACTIVE COMPARATOR

Volar Wrist block group. Local anesthetic is placed at this location in this study group. The same local composition (Intervention) is used for both study groups. The trial is a comparison of location not the Intervention.

Procedure: Volar Wrist Block

Interventions

Volar Wrist Block PROCEDURE

Injection medial to Flexor Carpi Ulnaris Tendon at volar proximal wrist crease Local Block - total 3 cc injection (1.5 cc 1% plain lidocaine and 1.5 cc of 0.25% bupivicaine)

Volar Wrist Block

Hypothenar Palm block PROCEDURE

Injection at Hook of the Hamate on Palmar surface Local Block - total 3 cc injection (1.5 cc 1% plain lidocaine and 1.5 cc of 0.25% bupivicaine)

Hypothenar Palm block

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• any individual who can give informed consent and is scheduled for elective hand procedures by the PI necessitating an Ulnar nerve block of the hand.

You may not qualify if:

• patients unable to give informed consent
• patients with previous or ongoing ulnar nerve deficits or neuropathy
• patients undergoing Guyon's canal decompression
• patients who can not comprehend or cooperate with assessment testing
• patients with abnormal two point discrimination (\> 6 mm at the test location) prior to the nerve block

Sponsors & Collaborators

• Hamilton Health Sciences Corporation: lead
• McMaster University: collaborator

Study Sites (1)

Hamilton General Hospital

Hamilton, Ontario, Canada

Location

Study Officials

• Stuart Martin

  McMaster University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: INVESTIGATOR
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 21, 2009
• First Posted: January 23, 2009
• Study Start: February 1, 2008
• Primary Completion: July 1, 2009
• Study Completion: July 1, 2009
• Last Updated: May 14, 2018

Record last verified: 2018-05

Locations

CA (1)