Hemidiaphragmatic Paralysis Following Supraclavicular Brachial Plexus Blockade.

NCT06491498 | Not Yet Recruiting

• 1 other identifier: Soh-Med-24-05-14MS
• Study Type: observational
• Target: 60
• Locations: 0 countries
• Sites: N/A

Brief Summary

The supraclavicular block is a regional anesthetic technique used as an alternative or adjunct to general anesthesia or used for postoperative pain control for upper extremity surgeries (mid-humerus through the hand). First introduced in 1911 by Kulenkampff as a landmark-based approach, the associated risk of pneumothorax was likely responsible for the technique falling out of favor. With the advent of ultrasonography, La Grange described the utilization of the Doppler probe to identify arteries in 1978. Contemporarily, Kapral and colleagues advocated for the dynamic use of ultrasound to guide needle advancement in the supraclavicular position. Colloquially known as the "spinal of the arm," the supraclavicular block is advantageous as the brachial plexus nerves are tightly packed in this approach and speed of onset is often rapidly achieved. However, because of this consolidated relationship, consider restricting volumes of local anesthesia to as low as possible to achieve goals, as compression ischemia may occur.

Conditions

Respiratory Depression

Outcome Measures

Primary Outcomes (1)

• incidences of hemi diaphragmatic paralysis following ultrasound-guided supraclavicular plexus blockade

  By Using M-mode Ultrasonography showing the limitation of diaphragmatic motion before and after supraclavicular brachial plexus blockade

  2 hours

Secondary Outcomes (2)

• Evaluation of post operative pain by visual analog scale

  2 hours

• Evaluation of oxygen saturation by pulse oximeter

  2 hours

Study Arms (2)

Group R in the right upper limb.

Group R (30) will receive 15 mL of 0.5% bupivacaine with dexametomidine by dose 1 μg / kg in the right upper limb.

Diagnostic Test: Supraclavicular Brachial Plexus Blockade

Groub L in the left upper limb.

Groub L (30) will receive 15 mL of 0.5% bupivacaine with dexametomidine by dose 1 μg / kg in the left upper limb.

Diagnostic Test: Supraclavicular Brachial Plexus Blockade

Interventions

Supraclavicular Brachial Plexus Blockade DIAGNOSTIC_TEST

Hemidiaphragmatic Paralysis Following Ultrasound-Guided Supraclavicular Brachial Plexus Blockade in patients undergoing upper limb surgery

Groub L in the left upper limb.; Group R in the right upper limb.

Eligibility Criteria

• Age: 18 Years - 60 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)
• Sampling Method: Probability Sample

Study Population

Age between 18 and 60 years. American Society of Anesthesiologists physical status 1 to 3, Able to give informed consent. Body mass index (BMI) less than 35.

You may qualify if:

• Age between 18 and 60 years. American Society of Anesthesiologists physical status 1 to 3, Able to give informed consent. Body mass index (BMI) less than 35.

You may not qualify if:

• Patient refusal. Known/suspected allergy to local anesthetics Pregnancy Body mass index (BMI) greater than 35 kg/m2 Neuromuscular disease Obstructive or restrictive pulmonary disease Known or suspected PNP or diaphragmatic dysfunction Other medical or anatomic contraindication to brachial plexus blockade as judged by the investigator
• local infection.
• significant coagulation abnormalities.

Sponsors & Collaborators

• Sohag University: lead

Related Publications (4)

• Bigeleisen PE. Anatomical variations of the phrenic nerve and its clinical implication for supraclavicular block. Br J Anaesth. 2003 Dec;91(6):916-7. doi: 10.1093/bja/aeg254.

  PMID: 14633767 BACKGROUND

• Rose M, Ness TJ. Hypoxia following interscalene block. Reg Anesth Pain Med. 2002 Jan-Feb;27(1):94-6. doi: 10.1053/rapm.2002.29709.

  PMID: 11799511 BACKGROUND

• Erickson JM, Louis DS, Naughton NN. Symptomatic phrenic nerve palsy after supraclavicular block in an obese man. Orthopedics. 2009 May;32(5):368. doi: 10.3928/01477447-20090501-02.

  PMID: 19472948 BACKGROUND

• Feigl GC, Litz RJ, Marhofer P. Anatomy of the brachial plexus and its implications for daily clinical practice: regional anesthesia is applied anatomy. Reg Anesth Pain Med. 2020 Aug;45(8):620-627. doi: 10.1136/rapm-2020-101435. Epub 2020 May 28.

  PMID: 32471922 BACKGROUND

MeSH Terms

Conditions

Respiratory Insufficiency

Condition Hierarchy (Ancestors)

Respiration Disorders; Respiratory Tract Diseases

Study Officials

• Magdy M Amin, Professor

  Sohag University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Abanob Y Mosaad, Resident

CONTACT

01211365548; aym2014.ay@gmail.com

Ahmed E Abd-elrahmaan, Prof

CONTACT

01118011611

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Resident in Anesthesia and ICU department faculty of medicine, Sohag university

Study Record Dates

• First Submitted: June 3, 2024
• First Posted: July 9, 2024
• Study Start: July 1, 2024
• Primary Completion: January 1, 2025
• Study Completion: February 1, 2025
• Last Updated: July 9, 2024

Record last verified: 2024-07