Hand Injuries Clinical Trial
Official title:
Retroclavicular Approach vs Infraclavicular Approach for Brachial Plexus Block in Obese
The retroclavicular approach for brachial plexus anesthesia requires an optimal angle between the needle and the ultrasound beam. Retroclavicular approach has already been proven effective and safe in the past. The general objective is to provide a formal comparison between the retroclavicular approach and coracoid infraclavicular approach for brachial plexus anaesthesia. This study should represent the differences between the two techniques.
Classic infraclavicular approach of the brachial plexus involves a needle puncture below the
clavicle and advancing the needle with a 45-60 degree angle from cephalad to caudad. The aim
is to advanced the block needle posterior to the axillary artery and to deposit the local
anesthetic at that point, near the posterior cord. A "U" shaped spread around the artery
should ensure distribution around all three cords. Ultrasound guidance is highly recommended
and neurostimulation is optional.
The retroclavicular approach is a variant to this classical technique. Ultrasound probe is
positioned initially below the clavicle in a manner similar to the classic approach but is
then rotated in a clockwise fashion (right arm) or counter-clockwise fashion (left arm) for
about 25-35 degrees. The puncture site is just behind the clavicle at the most lateral point
available. If initial entry point is optimal, needle direction is then parallel to
ultrasound probe. The final aim and position of block needle is identical to classical
approach. Entry point ensures a parallel alignment of the needle and the ultrasound beam,
thus enabling almost perfect visualization of both artery, cords and block needle. This is
turn optimizes safety, rapidity of technique, efficiency and efficacy.
It is recognized that regional anesthesia is more difficult to perform in obese patients.
Anatomic landmarks are harder to localize in this population and ultrasound guidance is more
difficult because of the attenuation of the ultrasound beam by adipose tissue. The
complication rate of regional techniques is also reported to be higher in the obese patient
population.
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Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Double Blind (Investigator, Outcomes Assessor)
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