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SuspendedNCT03291691ProNervUpdated Feb 4, 2022

Protective Nerve Stimulation in Regional Anesthesia

An observational study in Anesthesia, Local, Nerve Block and Brachial Plexus Block, sponsored by Charite University, Berlin, Germany. Suspended at 1 site in Germany. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2022-02-04.

Sponsored by Charite University, Berlin, Germany · Observational

Why this study was suspended
for organizational reasons
Study type
Observational
Model
Cohort
Time perspective
Prospective
Enrollment
60
Ages
18 Years and older
Sex
All
01

Study summary

Peripheral nerve blocks can be conducted with ultrasound, electrical nerve stimulation or landmark technique or a combination of this techniques. Whether a regional block should be conducted with a combination of those different possibilities is highly discussed. In this study the investigators want to show the effectiveness of new standard way of combined use of ultrasound and nerve stimulation, they call protective nerve stimulation. According to ethical vote we are conducting an observational study.

Read the detailed description

All patients will get the regional block they need for the elective surgery. Before starting the block a standard monitoring will be established. After applying the monitoring the block will be performed by an experienced anesthetist in supervision of another experienced anesthetist. The nerve stimulator is set on a fixed current of 1.0 mA and a block without motoric response on this current is tried. Ultrasound images are saved. After performing the regional anesthesia the further anesthetic procedure will be carried out and the surgery will take place. After surgery the patients will be transported to the recovery room or Postanesthesia care unit.

02

Conditions studied

  • Anesthesia, Local
  • Nerve Block
  • Brachial Plexus Block

Keywords

  • Protective Nerve Stimulation
  • Regional Anesthesia
  • Sciatic nerve block
  • femoral nerve block
  • brachial plexus block
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Probability sample

Study population

60 female and male patients undergoing elective surgery with a regional block at Charité -Universitätsmedizin Berlin

Inclusion criteria

  • written informed consent
  • age of 18 or older
  • elective surgery patients at Campus Charité Mitte with clinical benefit of regional anesthesia

Exclusion criteria

Exclusion Criteria:

  • existing contraindication for regional nerve blocks or the use of Protective Nerve Stimulation
  • patients who undergo outpatient treatment
  • allergy against local anesthetics
  • age under 18 years
  • Lacking willingness to take part in the study
  • ASA PS score of 4 or more
  • preexisting neural damage in the effect area
  • Diabetes mellitus, alcohol use disorder
  • Participation in other prospective clinical interventional trials
  • Accommodation in an institution due to an official or judicial order
04

Study design

Observational model
Cohort
Time perspective
Prospective
Enrollment
60 participants (estimated)
Patient registry
No

Groups and cohorts

  • Standard of care: SCI

    Patients at Charite, with lower limb surgery undergoing a protective performed ultrasound guided sciatic nerve block. N=15.

  • Standard of care: FEM

    Patients at Charite, with lower limb surgery undergoing a protective performed ultrasound guided femoral nerve block. N=15.

  • Standard of care: ISB

    Patients at Charite, with upper limb surgery undergoing a protective performed ultrasound guided interscalene plexus block. N=15.

  • Standard of care: AXP

    Patients at Charite, with upper limb surgery undergoing a protective performed ultrasound guided axillary plexus block. N=15.

05

What researchers measure

Primary outcomes

  1. Effectivity

    Effective motor blockade and sensitive blockade at fixed timepoints

    Time frame: Duration of preparation, surgery and recovery room (an average of 4 hours)

Secondary outcomes

  1. Muscle contractions

    Number of expected and unexpected muscle contractions

    Time frame: Duration of preparation, surgery and recovery room (an average of 4 hours)

  2. Paresthesia

    Number of expected and unexpected paresthesia

    Time frame: Duration of preparation, surgery and recovery room (an average of 4 hours)

  3. Pain while blocking

    Does the patient have pain while blocking? Pain during hospital stay will be measured with the Numeric Rating Scale (NRS-V). For patients unable of pain self-assessment (e.g. ventilated patients, patients in delirious state or patients with stroke affecting language skills) observer-rated pain scales will be applied: Behavioural Pain Scale (BPS for ventilated) and BPS-NI (for non-ventilated) patients.

    Time frame: Duration of preparation, surgery and recovery room (an average of 4 hours)

  4. Pain after surgery

    Does the patient have pain after surgery? Pain during hospital stay will be measured with the Numeric Rating Scale (NRS-V). For patients unable of pain self-assessment (e.g. ventilated patients, patients in delirious state or patients with stroke affecting language skills) observer-rated pain scales will be applied: Behavioural Pain Scale (BPS for ventilated) and BPS-NI (for non-ventilated) patients.

    Time frame: Duration of preparation, surgery and recovery room (an average of 4 hours)

  5. Satisfaction

    Satisfaction of the patient in a 6-step Likert scale

    Time frame: Duration of preparation, surgery and recovery room (an average of 4 hours)

  6. Impedance

    impedance measured by the nerve stimulator while proceeding with the needle

    Time frame: Duration of preparation, surgery and recovery room (an average of 4 hours)

  7. Changes of impedance

    changes of impedance measured by the nerve stimulator while proceeding with the needle

    Time frame: Duration of preparation, surgery and recovery room (an average of 4 hours)

Other outcomes

  1. Bloody Tap

    Appearance of Bloody Tap before, during and after the block (yes/no)

    Time frame: Duration of preparation, surgery and recovery room (an average of 4 hours)

  2. Postoperative Nausea and Vomiting

    Appearance of PONV before, during and after the block (yes/no)

    Time frame: Duration of preparation, surgery and recovery room (an average of 4 hours)

  3. pruritus

    Appearance of pruritus before, during and after the block (yes/no)

    Time frame: Duration of preparation, surgery and recovery room (an average of 4 hours)

  4. Analgetics consumption

    Amount of opioids needed before, during and after the surgery until the patient leaves the recovery unit

    Time frame: Duration of preparation, surgery and recovery room (an average of 4 hours)

06

Study locations

1 site
  • Charité - Universitätsmedizin Berlin Campus Charité Mitte
    Berlin, 10117, Germany
07

References and documents

Publications

  • Salem MH, Winckelmann J, Geiger P, Mehrkens HH, Salem KH. Electrostimulation with or without ultrasound-guidance in interscalene brachial plexus block for shoulder surgery. J Anesth. 2012 Aug;26(4):610-3. doi: 10.1007/s00540-012-1366-x. Epub 2012 Mar 4. PubMed 22391670 ↗
  • Klaastad O, Sauter AR, Dodgson MS. Brachial plexus block with or without ultrasound guidance. Curr Opin Anaesthesiol. 2009 Oct;22(5):655-60. doi: 10.1097/ACO.0b013e32832eb7d3. PubMed 19550303 ↗
  • Dillane D, Tsui BC. Is there still a place for the use of nerve stimulation? Paediatr Anaesth. 2012 Jan;22(1):102-8. doi: 10.1111/j.1460-9592.2011.03729.x. Epub 2011 Nov 4. PubMed 22050512 ↗
  • Vassiliou T, Muller HH, Limberg S, De Andres J, Steinfeldt T, Wiesmann T. Risk evaluation for needle-nerve contact related to electrical nerve stimulation in a porcine model. Acta Anaesthesiol Scand. 2016 Mar;60(3):400-6. doi: 10.1111/aas.12664. Epub 2015 Dec 15. PubMed 26666693 ↗
  • Dexter F, Candiotti KA. Multicenter assessment of the Iowa Satisfaction with Anesthesia Scale, an instrument that measures patient satisfaction with monitored anesthesia care. Anesth Analg. 2011 Aug;113(2):364-8. doi: 10.1213/ANE.0b013e318217f804. Epub 2011 Apr 25. PubMed 21519043 ↗
  • Wiesmann T, Borntrager A, Vassiliou T, Hadzic A, Wulf H, Muller HH, Steinfeldt T. Minimal current intensity to elicit an evoked motor response cannot discern between needle-nerve contact and intraneural needle insertion. Anesth Analg. 2014 Mar;118(3):681-6. doi: 10.1213/ANE.0b013e3182a94454. PubMed 24284806 ↗
  • Wiesmann T, Steinfeldt T, Exner M, Nimphius W, De Andres J, Wulf H, Schwemmer U. Intraneural injection of a test dose of local anesthetic in peripheral nerves - does it induce histological changes in nerve tissue? Acta Anaesthesiol Scand. 2017 Jan;61(1):91-98. doi: 10.1111/aas.12825. Epub 2016 Oct 25. PubMed 27778324 ↗
  • Sen O, Sayilgan NC, Tutuncu AC, Bakan M, Koksal GM, Oz H. Evaluation of sciatic nerve damage following intraneural injection of bupivacaine, levobupivacaine and lidocaine in rats. Braz J Anesthesiol. 2016 May-Jun;66(3):272-5. doi: 10.1016/j.bjane.2014.09.012. Epub 2015 Mar 12. PubMed 27108824 ↗
  • Brull R, McCartney CJ, Chan VW, El-Beheiry H. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007 Apr;104(4):965-74. doi: 10.1213/01.ane.0000258740.17193.ec. PubMed 17377115 ↗

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT03291691
Lead sponsor
Charite University, Berlin, Germany
Responsible party
Jurgen Birnbaum (Principal Investigator and Consultant of the Department of Anesthesiology and Operative Intensive Care Medicine, CCM and CVK, Charite University, Berlin, Germany) — Principal investigator
First posted
Sep 25, 2017
Start date
Sep 20, 2017
Primary completion
Dec 31, 2023 (estimated)
Completion
Dec 31, 2023 (estimated)
Last update
Feb 4, 2022

Study contacts

Jürgen Birnbaum, MD
principal investigator · Charite University, Berlin, Germany

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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