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Trial registered on ANZCTR
Registration number
ACTRN12618000129280
Ethics application status
Approved
Date submitted
22/11/2017
Date registered
30/01/2018
Date last updated
30/01/2018
Type of registration
Retrospectively registered
Titles & IDs
Public title
In patients receiving regional anaesthesia of the arm for arteriovenous(AV) fistula surgery, can washout with normal saline increase the speed of resolution of the block after the surgery has been completed.
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Scientific title
Reversing the effects of peripheral nerve block in patients undergoing AV fistula surgery using normal saline to "wash off" the block with 10mL of saline every 15 minutes following the surgery speed the offset of the block in terms of return of motor and sensory function.
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Secondary ID [1]
293424
0
None
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Regional anaesthesia
305581
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Condition category
Condition code
Anaesthesiology
304811
304811
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0
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Anaesthetics
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Following completion of AV fistula surgery the patient is transferred to the recovery room. Here a recovery nurse will flush 10ml of normal saline down the peripheral nerve catheter every 15 minutes for one hour, in the intervention group, and the control group has nothing done to the catheter. A blinded observer then assesses the patients block, 4 times during the hour that the patient stays in recovery. They assess the motor and sensory function in the 4 major nerves of the arm, and assess the pain scores of the patient.
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Intervention code [1]
299666
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Treatment: Other
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Comparator / control treatment
Control group has a peripheral nerve catheter, but no washout.
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Control group
Active
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Outcomes
Primary outcome [1]
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Motor function is assessed with movements controlled by the 4 major nerves and graded on Bromage score of 0 to 5 depending on the strength of the movement.
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Assessment method [1]
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Timepoint [1]
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There are 4 assessments of the patients block during their time in recovery. These are timed to be 5 minutes after the intervention (normal saline flush), in the intervention group and at the same time in the control group. This means the block is assessed when the patient first reaches recovery and then every 15 minutes for one hour.
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Primary outcome [2]
304318
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Sensory function of the forearm in terms of light touch and temperature sensation in the 4 nerve territories of the arm.
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Assessment method [2]
304318
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Timepoint [2]
304318
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Every 15 minutes for 1 hour.
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Primary outcome [3]
304319
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Pain scores self reported by the patient on scale of 1-10.
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Assessment method [3]
304319
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Timepoint [3]
304319
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Every 15 minutes for one hour.
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Secondary outcome [1]
341572
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None
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Assessment method [1]
341572
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Timepoint [1]
341572
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None
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Eligibility
Key inclusion criteria
• Provide informed written consent
• Adult (18 years or older) patients
• Having AV fistula formation under brachial plexus block
The patients block is measured on first admission to recovery room, and then every 15 minutes for one hour while in the recovery room. AV fistula patients are routinely discharged home after one hour in recovery.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
• Failure to provide informed consent
• Infection at the needle insertion site
• Known coagulopathy
• Known allergy to local anesthetics
• Presence of sensory or motor impairment in the distribution of the brachial plexus prior to nerve blockade
• Inability to perform valid sensory or motor assessment due to impaired access to the limb, language barrier, or inability of the subject to co-operate with such examination
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
20 patients will be allocated to each group, so 40 slips of paper containing the group allocation will be placed into envelopes that will be drawn randomly from a box when a patient is recruited into the study.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Randomly drawn envelope.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Data will be recorded on a data sheet and transferred to an Excel spreadsheet for statistical analysis. Comparisons between groups will be performed with Student’s t-test. Qualitative data will be reported as either absolute numbers or percentage and will be analyzed by Chi-square analysis or Fisher’s exact test, whichever is appropriate. A p value of < 0.05 will be considered statistically significant.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
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Actual
10/11/2014
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Date of last participant enrolment
Anticipated
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Actual
20/01/2016
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Date of last data collection
Anticipated
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Actual
20/01/2016
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Sample size
Target
40
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Accrual to date
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Final
37
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Recruitment outside Australia
Country [1]
9390
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New Zealand
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State/province [1]
9390
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Waikato
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Funding & Sponsors
Funding source category [1]
298049
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Hospital
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Name [1]
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Waikato hospital
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Address [1]
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Dept. of Anaesthesia
Waikato hospital
Pembroke Street
Hamilton 3200
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Country [1]
298049
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New Zealand
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Primary sponsor type
Hospital
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Name
Waikato hospital
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Address
Pembroke Street
Hamilton 3200
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Country
New Zealand
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Secondary sponsor category [1]
297123
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None
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Name [1]
297123
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Nil
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Address [1]
297123
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Nil
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Country [1]
297123
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
299071
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Northern B Ethics committee
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Ethics committee address [1]
299071
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Health and Disability Ethics Committees Ministry of Health C/- MEDSAFE, Level 6, Deloitte House 10 Brandon Street PO Box 5013 Wellington 6011
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Ethics committee country [1]
299071
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New Zealand
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Date submitted for ethics approval [1]
299071
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15/03/2014
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Approval date [1]
299071
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01/05/2014
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Ethics approval number [1]
299071
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14/NTB/45
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Summary
Brief summary
Background and rationale Peripheral nerve blocks provide effective surgical anesthesia targeted to specific body regions while avoiding the unpleasant side-effects of general anesthesia. There are occasions when rapid and effective block reversal is needed. For example, interscalene brachial plexus block for upper extremity surgery frequently causes paralysis of the diaphragm due to inadvertent anesthesia of the phrenic nerve. A method to ‘wash out’ the local anesthetic around the phrenic nerve in these cases would be beneficial, Or in cases where patients are being discharged home the same day, and normal motor and sensory function of the limb in beneficial. Several studies have demonstrated that epidural washout using normal saline (NS) or Ringer’s lactate following epidural block facilitates more rapid recovery of motor function and sensation than letting the block resolve on its own. However, no studies to date have addressed whether washout is effective for reversal of peripheral nerve blocks. A recently published report suggests that a bolus of NS through a perineural catheter can rapidly and effectively restore phrenic nerve function following interscalene block. Study objective To demonstrate that infusion bolus of NS can be used in a clinical setting to modify the properties of a nerve block in patients who have received a nerve block for surgery and are expected to have minimal pain post operatively. Hypothesis We hypothesize that NS can be delivered through a perineural catheter to ‘wash out’ a nerve block to the point that function of the nerves returns. .
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Trial website
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Trial related presentations / publications
Smith C, Byrne K, Termaat J, Tsui B. A simple method to reverse peripheral nerve blockade. Poster presentation at the NZ Anaesthesia Annual Scientific Meeting, Rotorua, November 8-11, 2017.
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Public notes
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Contacts
Principal investigator
Name
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Dr Kelly Byrne
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Address
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Dept. of Anaesthesia
Waikato hospital
Pembroke Street
Hamilton 3200
New Zealand
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Country
79194
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New Zealand
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Phone
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+642102224390
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Fax
79194
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Email
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[email protected]
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Contact person for public queries
Name
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Kelly Byrne
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Address
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Dept. of Anaesthesia
Waikato hospital
Pembroke Street
Hamilton 3200
New Zealand
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Country
79195
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New Zealand
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Phone
79195
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+642102224390
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Fax
79195
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Email
79195
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[email protected]
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Contact person for scientific queries
Name
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Kelly Byrne
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Address
79196
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Dept. of Anaesthesia
Waikato hospital
Pembroke Street
Hamilton 3200
New Zealand
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Country
79196
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New Zealand
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Phone
79196
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+642102224390
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Fax
79196
0
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Email
79196
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
Type
Is Peer Reviewed?
DOI
Citations or Other Details
Attachment
Plain language summary
No
No difference between the groups
Study results article
Yes
Reversing the Effects of a Peripheral Nerve Block ...
[
More Details
]
374034-(Uploaded-15-05-2020-09-23-42)-Journal results publication.pdf
Documents added automatically
Source
Title
Year of Publication
DOI
Dimensions AI
Reversing the Effects of a Peripheral Nerve Block with Normal Saline: A Randomised Controlled Trial
2020
https://doi.org/10.5152/tjar.2019.09076
N.B. These documents automatically identified may not have been verified by the study sponsor.
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