Determining the Minimal Effective Lidocaine Volume for Double-Injection Ultrasound-Guided Costoclavicular Nerve Block in Adults

What this Trial Is About

Researchers are investigating the minimum effective volume of lidocaine needed for a successful double-injection ultrasound-guided costoclavicular nerve block in patients undergoing upper extremity surgery below the elbow. This phase 4 study builds on prior evidence supporting the double-injection technique and aims to determine the dose that achieves a 90% success rate using a sequential dose assignment method called the Biased Coin Design. Participants will receive the nerve block with lidocaine 1.5% with epinephrine injected in two locations near specific nerves under ultrasound guidance. The dose for each patient depends on the previous patients response, adjusting up or down in increments, with a maximum volume of 40 mL to avoid toxicity. The study includes randomization to either the same successful dose or a lower dose. A catheter is placed to allow additional anesthetic if needed. During the study, patients will be assessed for block success 30 minutes after injection using a composite score. Other measures include operator experience, needle passes, block performance and onset times, anesthesia time, pain intensity during the procedure, and phrenic nerve block occurrence. The study involves blinding of operators and patients, with a total enrollment of 60 patients and completion planned by the end of 2026.

Minimal Effective Volume 90% for Double-injection Costoclavicular Block