Ignite Creation Date:
2024-07-17 @ 11:37 AM
Last Modification Date:
2024-10-26 @ 3:34 PM
Study NCT ID:
NCT06491498
Status:
NOT_YET_RECRUITING
Last Update Posted:
2024-07-09
First Post:
2024-06-03
Brief Title:
Hemidiaphragmatic Paralysis Following Supraclavicular Brachial Plexus Blockade
Sponsor:
Sohag University
Organization:
Sohag University
Study Overview
Official Title:
Hemidiaphragmatic Paralysis Following Ultrasound-Guided Supraclavicular Brachial Plexus Blockade in Patients Undergoing Upper Limb Surgery
Status:
NOT_YET_RECRUITING
Status Verified Date:
2024-07
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
The supraclavicular block is a regional anesthetic technique used as an alternative or adjunct to general anesthesia or used for postoperative pain control for upper extremity surgeries mid-humerus through the hand First introduced in 1911 by Kulenkampff as a landmark-based approach the associated risk of pneumothorax was likely responsible for the technique falling out of favor With the advent of ultrasonography La Grange described the utilization of the Doppler probe to identify arteries in 1978 Contemporarily Kapral and colleagues advocated for the dynamic use of ultrasound to guide needle advancement in the supraclavicular position Colloquially known as the spinal of the arm the supraclavicular block is advantageous as the brachial plexus nerves are tightly packed in this approach and speed of onset is often rapidly achieved However because of this consolidated relationship consider restricting volumes of local anesthesia to as low as possible to achieve goals as compression ischemia may occur
Detailed Description:
The brachial plexus is formed by the anterior primary rami of C5 through T1 and provides sensory and motor innervation of the upper extremity The brachial plexus is divided proximally to distally into ramiroots trunks divisions cords and terminal branches The trunks can be found within the posterior triangle of the neck between the anterior and middle scalene muscles The brachial plexus along with the axillary artery can be considered as a large neurovascular bundle that travels in the axilla to supply the upper extremity
The brachial plexus provides somatic motor and sensory innervation to the upper extremity including the scapular region As the brachial plexus travels through the posterior triangle of the neck into the axilla arm forearm and hand it contains various named regions based on how the plexus is formed Ventral rami from spinal nerves C5 through T1 often referred to as roots of the brachial plexus come together to allow their fibers to intermingle forming superior inferior and middle trunks
The 3 trunks continue from the posterior triangle into the axilla with C5 and C6 roots forming the superior trunk C8 and T1 roots forming the inferior trunk and the C7 root continuing as the middle trunk
Continuing from the trunks are bundles that are called divisions Each of the trunks of the brachial plexus continues as an anterior and posterior division to form lateral posterior and medial cords
The phrenic nerve Comprised of the anterior branches of the C3-C5 spinal roots the phrenic nerve usually lies on the surface of the anterior scalene muscle underneath the sternocleidomastoid muscle before it enters the thorax behind the subclavian vein although anatomic variations are common Because of its close proximity to the brachial plexus Phrenic nerve palsy PNP resulting in ipsilateral hemi diaphragmatic paralysis which can occur following brachial plexus blockade
Hemi diaphragmatic paralysis HdP due to inadvertent phrenic nerve palsy PNP is a well-recognized complication of brachial plexus blockade the incidence of PNP has been reported to be as high as 100 following interscalene brachial plexus block and 50 to 67 following supraclavicular block While PNP is generally considered rare following infraclavicular block the incidence prior to the widespread adoption of ultrasound-guided regional anesthesia using solely landmark-based or nerve-stimulator techniques has been reported as high as 26
As the brachial plexus and phrenic nerve diverge from each other as they move caudally ultrasound-guided Supraclavicular Block SCB could be a safe reliable and effective alternative
Ultrasonography of the diaphragmatic dome is a straight-forward reliable non-invasive and reproducible method for assessing the activity of the diaphragm In fact Motion- mode can be used to assess diaphragmatic excursion ie displacement during a voluntary sniff test for which patients forcefully inhaled through the nose in a sniffing fashion This study will be conducted to evaluate the incidence of hemi diaphragmatic paralysis following ultrasound-guided supraclavicular plexus blockade
The brachial plexus provides somatic motor and sensory innervation to the upper extremity including the scapular region As the brachial plexus travels through the posterior triangle of the neck into the axilla arm forearm and hand it contains various named regions based on how the plexus is formed Ventral rami from spinal nerves C5 through T1 often referred to as roots of the brachial plexus come together to allow their fibers to intermingle forming superior inferior and middle trunks
The 3 trunks continue from the posterior triangle into the axilla with C5 and C6 roots forming the superior trunk C8 and T1 roots forming the inferior trunk and the C7 root continuing as the middle trunk
Continuing from the trunks are bundles that are called divisions Each of the trunks of the brachial plexus continues as an anterior and posterior division to form lateral posterior and medial cords
The phrenic nerve Comprised of the anterior branches of the C3-C5 spinal roots the phrenic nerve usually lies on the surface of the anterior scalene muscle underneath the sternocleidomastoid muscle before it enters the thorax behind the subclavian vein although anatomic variations are common Because of its close proximity to the brachial plexus Phrenic nerve palsy PNP resulting in ipsilateral hemi diaphragmatic paralysis which can occur following brachial plexus blockade
Hemi diaphragmatic paralysis HdP due to inadvertent phrenic nerve palsy PNP is a well-recognized complication of brachial plexus blockade the incidence of PNP has been reported to be as high as 100 following interscalene brachial plexus block and 50 to 67 following supraclavicular block While PNP is generally considered rare following infraclavicular block the incidence prior to the widespread adoption of ultrasound-guided regional anesthesia using solely landmark-based or nerve-stimulator techniques has been reported as high as 26
As the brachial plexus and phrenic nerve diverge from each other as they move caudally ultrasound-guided Supraclavicular Block SCB could be a safe reliable and effective alternative
Ultrasonography of the diaphragmatic dome is a straight-forward reliable non-invasive and reproducible method for assessing the activity of the diaphragm In fact Motion- mode can be used to assess diaphragmatic excursion ie displacement during a voluntary sniff test for which patients forcefully inhaled through the nose in a sniffing fashion This study will be conducted to evaluate the incidence of hemi diaphragmatic paralysis following ultrasound-guided supraclavicular plexus blockade
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None