Anesthesia, Local Clinical Trial
Official title:
The Effect of Forearm Nerve Blocks on Pain-free Tourniquet Time Compared to Local Anesthetic for Awake Hand Surgery
Wide-awake surgery with local anesthesia is a widely described approach to performing numerous minor hand procedures, such as tendon repairs and percutaneous fracture pinning, but is less frequently used for longer procedures such as open reduction internal fixation (ORIF). This is in part due to the need for a tourniquet for improved visualization, however pain-free tourniquet time with local anesthesia is roughly 20 minutes, shorter than the average time for ORIFs (Gillis), for example. While general anesthesia may still be avoided with more proximal blocks such as a brachial plexus or bier blocks, these still require presence of an anesthesiologist during the procedure, increasing human resource utilization and costs. Development of an anesthetic technique for hand surgery which could be performed by surgeons in a clinic setting, that still provides sufficiently long pain-free tourniquet times could decreases costs and wait times. The investigators hypothesize that the pain patients experience after 20 minutes of tourniquet application with local anesthetic infiltration is not due to direct pressure on the proximal arm, but rather distal digital ischemia pain. Previously, it has been shown that ultrasound-guided regional block of the median, radial, and ulnar nerves in the forearm is effective analgesia for awake hand surgery (Winter). Currently, there are no randomized studies investigating if forearm nerve blocks can prolong pain-free tourniquet time compared to local anesthesia infiltration, by blocking this ischemic pain in the distal arm. The investigators' objective is therefore to determine if forearm nerve blocks prolong pain-free tourniquet time compared to local anesthetic infiltration.
Status | Not yet recruiting |
Enrollment | 40 |
Est. completion date | May 1, 2023 |
Est. primary completion date | March 1, 2023 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - English speaking - 18 years of age or older at time of enrollment - are scheduled to undergo a minor hand surgery under local anesthesia Exclusion Criteria: - Patients with known allergies or intolerance to local anesthetic agents - Patients with known chronic pain disorders or peripheral neuropathies - Pediatric patients (<18 years of age) at the time of enrollment - Patients with a history of opioid (or other pain medication) substance use disorders |
Country | Name | City | State |
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n/a |
Lead Sponsor | Collaborator |
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University of Manitoba |
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Dekoninck V, Hoydonckx Y, Van de Velde M, Ory JP, Dubois J, Jamaer L, Jalil H, Stessel B. The analgesic efficacy of intravenous regional anesthesia with a forearm versus conventional upper arm tourniquet: a systematic review. BMC Anesthesiol. 2018 Jul 18;18(1):86. doi: 10.1186/s12871-018-0550-4. — View Citation
Farbood A, Khademi S, Tajvidi R, Hooshangi M, Salari S, Ghani M, Tahmasebi S, Jamali H. Comparison of Intravenous Regional Anesthesia with Single-Cuff Forearm Tourniquet and Hematoma Block and Traditional Method in Patients with Distal Radius Fractures; A Randomized Clinical Trial. Bull Emerg Trauma. 2020 Apr;8(2):77-82. doi: 10.30476/BEAT.2020.46446. — View Citation
Feehan LM, Sheps SB. Incidence and demographics of hand fractures in British Columbia, Canada: a population-based study. J Hand Surg Am. 2006 Sep;31(7):1068-74. — View Citation
Gillis JA, Williams JG. Cost analysis of percutaneous fixation of hand fractures in the main operating room versus the ambulatory setting. J Plast Reconstr Aesthet Surg. 2017 Aug;70(8):1044-1050. doi: 10.1016/j.bjps.2017.05.011. Epub 2017 May 20. — View Citation
Lovely LM, Chishti YZ, Woodland JL, Lalonde DH. How Much Volume of Local Anesthesia and How Long Should You Wait After Injection for an Effective Wrist Median Nerve Block? Hand (N Y). 2018 May;13(3):281-284. doi: 10.1177/1558944717709072. Epub 2017 May 26. — View Citation
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Steve AK, Schrag CH, Kuo A, Harrop AR. Metacarpal Fracture Fixation in a Minor Surgery Setting Versus Main Operating Room: A Cost-minimization Analysis. Plast Reconstr Surg Glob Open. 2019 Jul 5;7(7):e2298. doi: 10.1097/GOX.0000000000002298. eCollection 2019 Jul. — View Citation
Thompson NB, Calandruccio JH. Hand Surgery in the Ambulatory Surgery Center. Orthop Clin North Am. 2018 Jan;49(1):69-72. doi: 10.1016/j.ocl.2017.08.009. Review. — View Citation
Winter J, McLeod G, Quaife T, Petropolis C. Surgeon-administered Ultrasound-guided Peripheral Nerve Blocks in Outpatient Procedures of the Upper Extremity. Plast Reconstr Surg Glob Open. 2020 Nov 24;8(11):e3227. doi: 10.1097/GOX.0000000000003227. eCollection 2020 Nov. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Pain-free tourniquet time (minutes) | When upper extremity surgery is performed with local anesthesia and a tourniquet, the tourniquet must be removed after roughly 20 minutes as patients begin to feel tingling and pain in their hand.
Pain-free tourniquet time refers to the amount of time the tourniquet is applied before the patient begins to feel an uncomfortable sensation or pain in the arm to which the tourniquet is applied. Once pain occurs the tourniquet is released. This will be measured in minutes. |
Pain-free tourniquet time; from the time of tourniquet inflation until the patient experiences tourniquet pain, whichever occurs first |
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