Impact of Bupivacaine Dilution With Dextrose or Saline on Infraclavicular Block Outcomes
The Effect of Diluting Bupivacaine With 5% Dextrose and 0.9% NaCl on Block Success and Duration of Analgesia in Infraclavicular Block
Burçin Alaçam, MD
90 participants
Mar 9, 2026
INTERVENTIONAL
Conditions
Summary
D5W) has long been used as an intravenous fluid for hydration and energy supplementation and has recently gained increasing clinical interest in perineural injection therapies and ultrasound-guided hydrodissection. D5W has been shown to improve pain and functional outcomes in entrapment neuropathies by mechanically releasing perineural adhesions and potentially modulating neurogenic inflammation. In contrast, 0.9% sodium chloride (normal saline) is routinely used as a dilution medium for local anesthetics in peripheral nerve blocks; however, emerging evidence suggests that alternative diluents such as D5W may influence block onset and efficacy. The infraclavicular block is a commonly used ultrasound-guided technique for brachial plexus anesthesia, providing reliable anesthesia and postoperative analgesia for upper extremity surgery. This study aims to compare the effects of diluting bupivacaine with either D5W or 0.9% NaCl on block success and duration of analgesia in patients undergoing infraclavicular block. Secondary outcomes include block onset characteristics, sensory and motor block profiles, and perioperative analgesic requirements. The findings may help determine whether D5W represents a safe and effective alternative diluent to saline in routine regional anesthesia practice.
Eligibility
Inclusion Criteria5
- Patients who agree to participate in the study and provide written informed consent
- Patients scheduled for elective upper extremity surgery for whom infraclavicular block is considered appropriate for anesthetic management
- Age between 18 and 65 years
- American Society of Anesthesiologists (ASA) physical status I-III
- Patients with a normal neurological examination in the extremity scheduled for peripheral nerve block
Exclusion Criteria13
- Patients who decline to participate in the study or refuse to provide informed consent
- History of allergy or hypersensitivity to study medications
- Body mass index (BMI) ≥ 30 kg/m²
- Body weight less than 40 kg
- Age below 18 years or above 65 years
- History of significant cardiac disease (e.g., arrhythmia, conduction disorders)
- Presence of coagulopathy (international normalized ratio \[INR\] \> 1.5 and/or platelet count \< 100,000/mm³)
- Hepatic failure or significant liver dysfunction
- Pregnant patients
- Infection at the planned peripheral block site
- Presence of neurological deficit in the extremity planned for peripheral nerve block
- Patients with uncontrolled diabetes mellitus and/or established diabetic neuropathy
- American Society of Anesthesiologists (ASA) physical status IV
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Interventions
All eligible participants will be informed in detail about the study objectives, procedures, potential risks, and benefits by the responsible investigator, and all questions will be answered prior to enrollment. Written informed consent will be obtained from each participant before any study-related procedures are initiated. Following the ultrasound-guided infraclavicular block, sensory block assessment will be performed using a sterile single-use needle for a pinprick test. Light punctate stimuli will be applied to dermatomal areas corresponding to the branches of the brachial plexus on the blocked extremity. Participants will be asked to compare the sensation with the contralateral limb and to report the perceived sensation as "normal," "reduced," or "absent." Sensory block assessments will be performed at 5, 10, 15, 20, and 30 minutes after block administration. Sensory block onset time will be defined as the time point at which the participant reports absence of pinprick sensation
Locations(1)
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NCT07386327