Description of the Brachial Plexus Block at the Humeral Head in Children: a Sono-anatomical Study

Anesthesia, Local Clinical Trial

Official title:

Description of the Brachial Plexus Block at the Humeral Head in Children: a Sono-anatomical Study

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06158243
• Other study ID #: B062023230501
• Status: Not yet recruiting
• Start date: December 2023
• Est. completion date: April 2024

Study information

• Verified date: November 2023
• Source: Centre Hospitalier Universitaire Saint Pierre
• Contact: Raoul Ngatcha
• Phone: +32493869805
• Email: ngatchag[@]yahoo.fr
• Is FDA regulated: No
• Study type: Observational [Patient Registry]

Clinical Trial Summary

the investigators are interested in assessing the feasibility and value of brachial plexus block at the level of the humeral head in children. As a first step, the investigators propose to carry out a sono-anatomical study to describe the plexus at this level, the distribution of nerves in relation to the axillary artery, and the description of bone and muscle structures.

Description:

Brachial plexus blocks below the clavicle provide anesthesia and analgesia of the upper limb for elbow, forearm and hand surgery. Among the techniques described, axillary and costo-clavicular blocks are most frequently used.

In the axillary approach to the brachial plexus, the ulnar, median and radial nerves are in the direct vicinity of the axillary artery. However, there is considerable variability in the location of these nerves . What's more, the musculocutaneous nerve is most often distant from the other nerves of the plexus. These disadvantages are not encountered with the costo-clavicular technique, in which the nerves are brought together in the same diffusion space. On the other hand, this method does run the risk of pneumothorax and anesthesia of the phrenic nerve.

In this context, the investigators have described the brachial plexus block at the level of the humeral head in adults, which enables practicians to work on nerves gathered around the axillary artery without any risk of phrenic or pulmonary damage4.

In children, Small et al described a supra-clavicular approach, but Clayton et al, noting the high risk of pneumothorax, strongly advocated the axillary approach.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 50
• Est. completion date: April 2024
• Est. primary completion date: April 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 1 Month to 10 Years

Eligibility

Inclusion Criteria:

• patient ASA 1-2

• aged 0 to 10 years

• scheduled surgery

• parental consent obtained

Exclusion Criteria:

• Parental refusal to participate

• suspicion of local skin infection

• inability to place the limb in the position required for sonographic examination

• Upper limb malformation

• ASA III, IV

• Major surgery (cardiac, neurosurgery...)

• emergencies

Related Conditions & MeSH terms

• Anesthesia, Local

Intervention

Other:
• Sono-anatomical Study
The arm is abducted (90°), externally rotated, with the forearm flexed over the arm (90°). A linear ultrasound probe (8-15 MHz) is placed in front of the humeral head, in a sagittal plane. Location begins at axillary level, vessels, nerves and humerus are identified, and the probe is moved medially to reach and identify the humeral head.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Centre Hospitalier Universitaire Saint Pierre

References & Publications (4)

Christophe JL, Berthier F, Boillot A, Tatu L, Viennet A, Boichut N, Samain E. Assessment of topographic brachial plexus nerves variations at the axilla using ultrasonography. Br J Anaesth. 2009 Oct;103(4):606-12. doi: 10.1093/bja/aep207. Epub 2009 Aug 21. — View Citation

Li JW, Songthamwat B, Samy W, Sala-Blanch X, Karmakar MK. Ultrasound-Guided Costoclavicular Brachial Plexus Block: Sonoanatomy, Technique, and Block Dynamics. Reg Anesth Pain Med. 2017 Mar/Apr;42(2):233-240. doi: 10.1097/AAP.0000000000000566. — View Citation

Nalini KB, Bevinaguddaiah Y, Thiyagarajan B, Shivasankar A, Pujari VS. Ultrasound-guided costoclavicular vs. axillary brachial plexus block: A randomized clinical study. J Anaesthesiol Clin Pharmacol. 2021 Oct-Dec;37(4):655-660. doi: 10.4103/joacp.JOACP_43_20. Epub 2021 Nov 2. — View Citation

SMALL GA. Brachial plexus block anesthesia in children. J Am Med Assoc. 1951 Dec 22;147(17):1648-51. doi: 10.1001/jama.1951.03670340038009. No abstract available. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	description of the position of the nerves around the axillary artery	Hourly distribution of nerve structures around the axillary artery , expressed in degrees and measured with a protractor	through study completion, around 5 months
Secondary	distance between anatomical structures	depth of diffusion spaces Skin-cartilage distance Cartilage thickness Skin-nerve distance Skin-to-vessel distance size of nerves all these measurements in centimeters	through study completion, around 5 months

External Links

•   this work is the first we have done in adults " brachial intermediate nerve block"