Wrist Injuries Clinical Trial
Official title:
Comparison Between Infraclavicular Brachial Plexus Block Versus Local Infiltration for Postoperative Analgesia After Wrist Arthroscopy, a Prospective Randomized Open Label Study
The purpose of this study is to compare infraclavicular brachial plexus shot single shot block to local infiltration done in adult patients having wrist arthroscopy surgery. Visual analogue scores, opioid consumption, quality of recovery and quality of sleep up to 72 hours post operatively will be used for comparison.
If the patient is willing to participate and signs the consent, he/she will be randomized to
one of the two treatment groups:
1. Single shot block
2. Local Infiltration
In the institution investigators usually advocate for regional anesthesia and intravenous
sedation for the repair of open fracture of the distal radius.
Patients will be monitored during block performance with standard ASA monitors. All patients
will receive 2 L of oxygen via a nasal cannula. Sedatives will be titrated to effect.
Midazolam 1-2 mg, and fentanyl 50-100 mcg will be used for sedation.
Block time out will be preformed according to standard operating procedure. All blocks will
be done under ultrasound guidance. Sonosite S nerve machine will be used with a low frequency
curvilinear (C5) US probe with 2-5 MHZ frequency. Both single shot and local infiltration
will be performed according to the SOP in the department. Ultrasound survey of the
deltopectoral groove below the clavicle will take place. The axillary artery and the three
cords (posterior, medial and lateral) of the brachial plexus will be identified in short axis
view deeper to the pectoralis minor muscle.
For single shot blocks: A 4 inch 21 gauge single shot (B-Braun) needle will be introduced
in-plane towards the posterior cord of the brachial plexus and 1-2 mL of dextrose 5% (D5%)
bolus will be used to verify correct placement of the needle in the vicinity of the posterior
cord and adequate spread pattern to both lateral and medical cord. 20 ml of of Ropivicaine
0.5% will be injected through the needle with intermittent aspiration after each 5 ml bolus
injection.
For local infiltration: At the end of surgery, surgeon will inject 10 ml of Ropivacaine 0.5%
into the arthroscopy portals and the wrist. Specifically, 1 ml to 2 ml of Ropivacaine 0.5%
will be injected into each portal with the remainder of the volume injected into the joint
space itself.
Block success will be defined as a change in cutaneous sensation to touch with an alcohol pad
in the posterior, medial and lateral cord distribution over the forearm and the hand within
30min after injection. Subjects with successful catheter placement per protocol and nerve
block onset will be retained in the study. Subjects with a failed catheter insertion or
misplaced catheter indicated by a lack of sensory changes will have their catheter replaced
or will be single shot blocked and withdrawn from the study.
Intraoperative sedation will consist of intermittent boluses of midazolam (1-2 mg), fentanyl
(50-100 mcg) and propofol infusion, titrates to sedation and patient comfort (25-50
mcg/kg/min).
All patients will receive prophylaxis for postoperative nausea and vomiting (PONV) during
surgery. The protocol for prophylaxis against PONV includes administration of 4 mg of
dexamethasone after induction of anesthesia and 4 mg of ondansetron 20 minutes before
recovery from anesthesia. Dexamethasone is withheld if the patient has poorly controlled
diabetes mellitus (DM). Uncontrolled DM will be defined as random blood glucose above 250
mg/dl.
;
Status | Clinical Trial | Phase | |
---|---|---|---|
Not yet recruiting |
NCT05060900 -
Hand Ligament Reconstructions With Knee Collateral Ligament Allografts
|
N/A | |
Recruiting |
NCT04370626 -
The Canadian Prospective Pragmatic Perilunate Outcomes Trial
|
||
Completed |
NCT03038581 -
Comparison of Self-inflicted Deep Wrist Injuries to Traumatic Deep Wrist Injuries
|
||
Completed |
NCT01012271 -
Diagnostic Accuracy of Direct MR Arthrography Of The Wrist At 1.5, 3.0 And 7.0T
|
N/A | |
Completed |
NCT04842669 -
Effects of Low Level Laser Therapy On Exercise Induced Muscle Damage in Wrist Flexors Of Untrained Young Adults
|
N/A | |
Recruiting |
NCT03830775 -
A Prospective Randomized Double Blinded Controlled Trial of Non-Operative Management of TFCC Injuries
|
N/A | |
Recruiting |
NCT06086392 -
Perineural Dexamethasone in Supraclavicular Brachial Plexus Block for Anesthesia After Pediatric Hand/Wrist Surgery
|
Phase 4 | |
Withdrawn |
NCT02591810 -
Treatment Options for Acute Distal Radioulnar Joint Instability
|
N/A | |
Recruiting |
NCT06046404 -
Refraining From Closed Reduction of Dislocated Distal Radius Fractures in the Emergency Department
|
N/A | |
Completed |
NCT02435979 -
Proximal Strengthening for the Management of Wrist Pain
|
N/A | |
Completed |
NCT01857570 -
Volume CT of the Wrist and Carpus After Trauma
|
N/A | |
Completed |
NCT06426433 -
Investigation of The Effects of Proprioceptive Exercise Training on Motor Performance Parameters in Healthy Adults
|
N/A | |
Completed |
NCT04739644 -
Robot-based Wrist Rehabilitation in Orthopaedics: Efficacy and Comparison With Traditional Methods
|
N/A | |
Active, not recruiting |
NCT06067074 -
Cost-effectiveness, Volar Locking Plate or Non-operative Treatment Distal Radius Fracture
|
N/A | |
Recruiting |
NCT02401568 -
Morphologic and Biomechanical Analysis of the Carpal Ligaments
|
N/A | |
Terminated |
NCT02058303 -
Study of A Long Lasting Local Anesthestic for Hand, Wrist or Finger Surgery
|
Phase 4 | |
Completed |
NCT03788954 -
Effect of Kinesiotaping on Wrist Kinematics and Functional Performance
|
N/A | |
Completed |
NCT02630290 -
Addition of Dexmedetomidine to Ropivacaine-induced Supraclavicular Block (ADRIB Trial)
|
Phase 4 | |
Withdrawn |
NCT04527588 -
Italian Translation of the Michigan Hand Outcomes Questionnaire
|
||
Active, not recruiting |
NCT02911610 -
Assessment of Arthroscopy in Patients Undergoing Wrist Fracture
|
N/A |