Ultrasound-guided supraclavicular brachial plexus block versus intravenous regional anaesthesia for the manipulation of fractures of the distal radius

ISRCTN ISRCTN08332539
DOI https://doi.org/10.1186/ISRCTN08332539
Secondary identifying numbers V 2.0
Submission date
28/05/2010
Registration date
31/08/2010
Last edited
18/04/2017
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Injury, Occupational Diseases, Poisoning
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

Plain English summary of protocol

Not provided at time of registration

Contact information

Dr Thomas Locker
Scientific

Emergency Department
Barnsley Hospital NHS Foundation Trust
Gawber Road
Barnsley
S75 2EP
United Kingdom

Study information

Study designRandomised controlled trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details to request a patient information sheet
Scientific titleUltrasound-guided supraclavicular brachial plexus block versus intravenous regional anaesthesia for the manipulation of fractures of the distal radius: a randomised controlled trial
Study acronymSCivi
Study objectivesIs ultrasound-guided brachial plexus block equivalent to intravenous regional anaesthesia in providing pain relief for the manipulation of fracutres of the distal radius?
Ethics approval(s)Not provided at time of registration
Health condition(s) or problem(s) studiedDistal radius fractures
InterventionIntravenous regional anaesthesia:
An intravenous cannula will be placed in the dorsum of the hand of the affected limb and a second cannula placed in the contralateral limb. A suitably sized double cuff tourniquet will be placed around the upper arm over a layer of orthopaedic wool. The limb will be elevated for two minutes and the tourniquet inflated to 80 mmHg above the systolic blood pressure. Following confirmation of the absence of a radial pulse and capillary refill in the fingers the dose of 0.5% prilocaine will be injected via the cannula in the dorsum of the affected hand. The volume injected will be 40 ml for patients weighing less than 70 kg and 50 ml for those 70 kg and over. Once anaesthesia has been confirmed by the absence of pin-prick sensation as outlined below, the manipulation will be performed. The tourniquet will remain inflated for a minimum of 20 minutes from the time of injection.

Supraclavicular brachial plexus block:
The intervention group will undergo an ultrasound-guided brachial plexus block using the following technique: an intravenous cannula will be placed in the non-affected hand. The block will be performed using a sterile technique (sterile gloves, chlorhexidine spray, sterile probe cover). Visualisation of the brachical plexus will be undertaken with a Siemens Acuson X300 ultrasound machine with 10 MHz linear array probe. A view of the subclavian artery and surrounding nerve trunks will be obtained with the probe placed in the supraclavicular fossa in the coronal oblique plane. With the patient supine and the head turned at 45 degrees away from the probe. 1 ml of 1% lignocaine will be infiltrated in the skin at the injection site. A 22 gauge 50 mm short bevelled insulated block needle (Braun, Stimuplex) will be inserted at the lateral edge of the probe. The needle will be guided under direct vision from lateral to medial along the long axis of the probe using an in-plane approach. A total of 20 ml of 1% prilocaine will be injected around the trunks with frequent aspiration to exclude inadvertent intravascular needle placement. Spread of local anaesthetic will be observed in real time. Injection will be into at least two separate areas around the nerve trunks.

Duration will be around 1 hour in total for each intervention. Total duration of follow-up will be until seen in fracture clinic. This will be approximately 3 to 7 days in both arms.
Intervention typeOther
Primary outcome measure1. Degree of pain experienced by the patient during manipulation, assessed by a Visual Analogue Scale (VAS) score
2. Overall satisfaction with procedure, assessed by a Visual Analogue Scale (VAS) score
3. Duration from randomisation to completion of the manipulation

Assessed at the end of the manipulation of the fracture, i.e. approximately one hour after entering the trial.
Secondary outcome measures1. Number of manipulations required
2. Emergency department (ED) length of stay
3. Time from commencing the procedure until discharge
4. Need for subsequent surgical intervention

Assessed at 3 - 7 days.
Overall study start date01/10/2010
Completion date01/10/2011

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participants68
Key inclusion criteria1. Aged greater than or equal to 18 years, either sex
2. Closed fracture of the distal third of the radius
3. Manipulation of the fracture required in the emergency department as judged by an emergency department middle grade doctor or consultant
Key exclusion criteria1. Confusion (Abbreviated Mental Test [AMT] less than 8)
2. Multiple injuries
3. Pre-existing sensory or motor deficit in the affected limb
4. Allergy to lignocaine or prilocaine
5. Any condition precluding the use of a tourniquet in the affected limb
6. Inability to read English
7. Middle grade doctor or consultant trained in intravenous regional anesthesia (IVRA) and supraclavicular block (SCB) not available
8. Significant pre-existing respiratory impairment (defined as exercise tolerance less than 100 metres on flat ground)
9. Anticoagulation, inherited bleeding disorders or any other known clotting or platelet deficiency or abnormality. The use of anti-platelet medications such as aspirin will not count as a contraindication.
Date of first enrolment01/10/2010
Date of final enrolment01/10/2011

Locations

Countries of recruitment

  • England
  • United Kingdom

Study participating centre

Barnsley Hospital NHS Foundation Trust
Barnsley
S75 2EP
United Kingdom

Sponsor information

Barnsley Hospital NHS Foundation Trust (UK)
Hospital/treatment centre

Gawber Road
Barnsley
S75 2EP
England
United Kingdom

Website http://www.barnsleyhospital.nhs.uk/
ROR logo "ROR" https://ror.org/00yx91b22

Funders

Funder type

Government

Barnsley Hospital NHS Foundation Trust (UK)

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Editorial Notes

18/04/2017: No publications found, verifying study status with principal investigator.