Upper Extremity Injury Clinical Trial
Official title:
A Randomized Comparison Between Single- and Double-injection Ultrasound-Guided Costoclavicular Block
In this trial, the objective is to compare single- and double-injection ultrasound-guided costoclavicular blocks. The rationale behind this idea is that a second local anesthetic injection, inside the costoclavicular space, may compensate for the dynamic cord dispersion seen with the single-injection technique. Thus the research hypothesis is that, compared to its single-injection counterpart, a double injection costoclavicular block will result in a shorter onset time.
The costoclavicular block (CCB) constitutes a relatively novel technique for infraclavicular
brachial plexus blockade, whereby local anesthetics (LAs) are injected inside the
costoclavicular space. In this location, the 3 cords of the brachial plexus are very tightly
clustered together; this topography would theoretically result in a very swift brachial
plexus block Unfortunately, in two recent trials comparing CCB and conventional
infraclavicular brachial plexus block, the authors were unable to detect differences in
success rate, onset times and LA requirement between the 2 methods. It could be speculated
that the explanation resides in dynamic cord dispersion. With CCB, the initial needle target
lies in the middle of the 3 cords of the brachial plexus. However, with LA injection, the
cords can quickly migrate away from each other. Thus, the anatomical benefits conveyed by the
initial compact topography may be lost.
In this trial, the objective is to compare single- and double-injection ultrasound-guided
costoclavicular blocks. The rationale behind this idea is that a second local anesthetic
injection, inside the costoclavicular space, may compensate for the dynamic cord dispersion
seen with the single-injection technique. Thus the research hypothesis is that, compared to
its single-injection counterpart, a double injection costoclavicular block will result in a
shorter onset time.
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