Ultrasound Visualization Versus Electrical Nerve Stimulation
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Purpose
Hypothesis and Specific Aims:
The investigators hypothesize that ultrasound (US) visualization is as effective as nerve stimulation (NS) for identification of peripheral nervous structures and may be associated with less trauma and patient discomfort. Specifically, the investigators believe that equivalent rates of surgical anesthesia are achievable with non-invasive ultrasonic needle guidance in comparison to needle guidance by intensity of motor fiber response to intermittent electrical nerve stimulation. Specifically, the number of needle sticks to identify the brachial plexus and total time to plexus sheath injection may be reduced while achieving similar efficacy rates. The investigators hypothesize that similar composite safety and efficacy endpoints but improved patient satisfaction and acceptance will favor US over NS guidance of nerve blocks indicated for surgery on the extremity surgery. However, the investigators believe that an economic assessment based upon capital hardware investment, operating room utilization, total block time, and pay for performance patient satisfaction metrics require examination prior to assimilation of new technology into clinical practice.
| Condition | Intervention | Phase |
|---|---|---|
|
Trauma to the Arm, Shoulder, Elbow, Forearm, or Hand |
Device: Ultrasound (Sonosite Titan T-shaped ultrasound probe) Device: Electrical Nerve Stimulation (Stimuplex (B Braun) needle) |
Phase 4 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Single Group Assignment Masking: Single Blind (Investigator) Primary Purpose: Treatment |
| Official Title: | Ultrasound Visualization v. Electrical Nerve Stimulation for the Safety and Effectiveness of Interscalene/Axillary Nerve Block in Upper Extremity Surgery: A Randomized Trial |
- Incidence of Successful Block: defined by avoidance of General Anesthesia (which will be documented in the medical record as such) [ Time Frame: 30 minutes after injection ] [ Designated as safety issue: Yes ]
- Amount of sedation required for block. (mg of drug) [ Time Frame: 30 minutes after injection ] [ Designated as safety issue: Yes ]
| Enrollment: | 158 |
| Study Start Date: | February 2009 |
| Study Completion Date: | October 2011 |
| Primary Completion Date: | March 2010 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Ultrasound
Ultrasound guided nerve localization through direct visualization of the nerves and surrounding structures.
|
Device: Ultrasound (Sonosite Titan T-shaped ultrasound probe)
Ultrasonography will allow direct visualization of nerves. As local anesthetic is injected, it can be seen surrounding the nerve.
Other Name: Sonosite Titan T-shaped ultrasound probe
|
|
Active Comparator: Nerve Stimulation
Standard of Care
|
Device: Electrical Nerve Stimulation (Stimuplex (B Braun) needle) |
Show Detailed Description
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Male or female patients older than 18 years of age at the time of screening
- ASA Class I - IV, undergoing unilateral elective surgical procedure involving the shoulder, arm, elbow, forearm, or hand
- Planned interscalene block
Exclusion Criteria:
- Peripheral neuropathy
- Coagulopathy
- Anticoagulant treatment that would preclude regional anesthesia
- Local anesthetic allergy
- Infection at the site of injection
Contacts and Locations| United States, Pennsylvania | |
| Lehigh Valley Hospital | |
| Allentown, Pennsylvania, United States, 18105 | |
| Principal Investigator: | Nanette Schwann, M.D. | Allentown Anesthesia Associates |
More Information
Publications:
| Responsible Party: | Nanette Schwann, M.D., MD, Allentown Anesthesia Associates |
| ClinicalTrials.gov Identifier: | NCT01010412 History of Changes |
| Other Study ID Numbers: | UVVENS |
| Study First Received: | November 9, 2009 |
| Last Updated: | August 29, 2012 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by Allentown Anesthesia Associates:
|
Ultrasound Nerve blocks Upper extremity |
ClinicalTrials.gov processed this record on May 16, 2013