xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT06027918</url>
    </required_header>
    <id_info>
      <org_study_id>12.09.2022/266</org_study_id>
      <nct_id>NCT06027918</nct_id>
    </id_info>
    <brief_title>The Effect of Altitude Difference on the Duration of Nerve Block; A Three-Center Study.</brief_title>
    <official_title>The Effect of Altitude Difference on the Duration of Infraclavicular Peripheral Block Applied to Patients With Hand and Forearm Fractures; a Three-center Study in Adults at 100, 675, 1726 Meters</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital</source>
    <oversight_info>
      <has_dmc>No</has_dmc>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        Infraclavicular brachial plexus block in hand and forearm surgery has the advantages of high&#xD;
        success rate and low risk of complications and is useful in providing long-lasting and&#xD;
        effective postoperative analgesia in these patients. In response to hypoxemia at high&#xD;
        altitude, increased blood viscosity, decreased carbon monoxide diffusion capacity, increased&#xD;
        cerebral arterial blood flow, decreased blood volume and decreased cardiac output occur. At&#xD;
        high altitude, the serum level of local anesthetics may increase due to an increase in their&#xD;
        ionized fraction and a decrease in their clearance. In this respect, the pharmacodynamic and&#xD;
        pharmacokinetic properties of peripheral nerve blocks may be altered when performed at high&#xD;
        altitude. The primary objective of this prospective study was to test the hypothesis that&#xD;
        postoperative pain scores are higher in patients undergoing infraclavicular nerve block at&#xD;
        high altitude than in patients at low altitude.&#xD;
  &#xD;
        This multicenter prospective randomized study will be initiated after approval of the Ethics&#xD;
        Committee of Health ScienceUniversity Diyarbakir Gazi Yasargil Training and Research&#xD;
        Hospital. Patients will be recruited simultaneously in 3 hospitals, Hatay Training and&#xD;
        Research Hospital, Hatay, Turkey (100 m above sea level);Health Science Health Science&#xD;
        University Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey (675 m&#xD;
        above sea level) and Health Science University Van Regional and Training Research Hospital,&#xD;
        Van, Turkey (1726 m above sea level).&#xD;
  &#xD;
        Infraclavicular brachial plexus blocks (coracoid approach) will be performed by administering&#xD;
        a local anesthetic mixture of 1.5 mg/kg lidocaine 2% + 1 mg/kg bupivacaine 0.5% at the 6&#xD;
        o'clock position of the axillary artery under US guidance.&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        Group V (1726 meter altitude): In the application of infraclavicular brachial plexus blocks&#xD;
        (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be&#xD;
        applied around the axillary artery in the 6 o'clock position under US guidance.&#xD;
  &#xD;
          -  The block will be applied only once, approximately 15-20 minutes before surgery.&#xD;
  &#xD;
          -  All patients will undergo electrocardiographic monitoring, oxygen saturation monitoring&#xD;
             with pulse oximetry and blood pressure measurement with automatic pneumatic manometer&#xD;
             before the application.&#xD;
  &#xD;
          -  Intravenous 1mg midazolam and 50 mcg fentanyl will be administered to all patients for&#xD;
             premedication before the procedure.&#xD;
  &#xD;
          -  The amount of medication to be given to all patients will be prepared as 1.5mg/kg&#xD;
             bupivacaine and 1mg/kg lidocaine.&#xD;
  &#xD;
          -  The prepared drug will be administered around the axillary artery at the appropriate&#xD;
             anatomical location determined under ultrasound guidance.&#xD;
  &#xD;
          -  Ultrasound device will be used as a supportive device during the application.&#xD;
  &#xD;
          -  The application will be performed by an anesthesiologist with at least 5 years of&#xD;
             experience.&#xD;
  &#xD;
          -  mode of delivery will be provided face to face and individually&#xD;
  &#xD;
          -  The administration will be only once, 20-30 minutes before the surgical procedure, with&#xD;
             a dose adjustment of 1.5mg/kg bupivacaine and 1mg/kg lidocaine per kilogram of weight.&#xD;
  &#xD;
          -  The application will be made in the preoperative preparation room in the operating room&#xD;
             of the hospital where the surgery will be performed.&#xD;
  &#xD;
          -  The local anesthetic dose to be used in the application will be calculated according to&#xD;
             the weight of the patient. local anesthetics will be prepared by another&#xD;
             anesthesiologist in the preoperative preparation room just before the application.&#xD;
  &#xD;
          -  In the postoperative period, if the pain intensity (VAS) is &lt;4, 100 mg paracetamol will&#xD;
             be administered intravenously, if VAS = 4, 100 mg tramadol will be administered&#xD;
             intravenously&#xD;
  &#xD;
        Group D (675 meter altitude): In the application of infraclavicular brachial plexus blocks&#xD;
        (coracoid approach); 1.5 mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be&#xD;
        applied around the axillary artery in the 6 o'clock position under US guidance.&#xD;
  &#xD;
          -  The block will be applied only once, approximately 15-20 minutes before surgery.&#xD;
  &#xD;
          -  All patients will undergo electrocardiographic monitoring, oxygen saturation monitoring&#xD;
             with pulse oximetry and blood pressure measurement with automatic pneumatic manometer&#xD;
             before the application.&#xD;
  &#xD;
          -  Intravenous 1mg midazolam and 50 mcg fentanyl will be administered to all patients for&#xD;
             premedication before the procedure.&#xD;
  &#xD;
          -  The amount of medication to be given to all patients will be prepared as 1.5 mg/kg&#xD;
             bupivacaine and 1mg/kg lidocaine.&#xD;
  &#xD;
          -  The prepared drug will be administered around the axillary artery at the appropriate&#xD;
             anatomical location determined under ultrasound guidance.&#xD;
  &#xD;
          -  Ultrasound device will be used as a supportive device during the application.&#xD;
  &#xD;
          -  The application will be performed by an anesthesiologist with at least 5 years of&#xD;
             experience.&#xD;
  &#xD;
          -  mode of delivery will be provided face to face and individually&#xD;
  &#xD;
          -  The administration will be only once, 20-30 minutes before the surgical procedure, with&#xD;
             a dose adjustment of 1.5 mg/kg bupivacaine and 1mg/kg lidocaine per kilogram of weight.&#xD;
  &#xD;
          -  The application will be made in the preoperative preparation room in the operating room&#xD;
             of the hospital where the surgery will be performed.&#xD;
  &#xD;
          -  The local anesthetic dose to be used in the application will be calculated according to&#xD;
             the weight of the patient. local anesthetics will be prepared by another&#xD;
             anesthesiologist in the preoperative preparation room just before the application.&#xD;
  &#xD;
          -  In the postoperative period, if the pain intensity (VAS) is &lt;4, 100 mg paracetamol will&#xD;
             be administered intravenously, if VAS = 4, 100 mg tramadol will be administered&#xD;
             intravenously&#xD;
  &#xD;
        Comparator / control treatment Group H (100 meter altitude): In the application of&#xD;
        infraclavicular brachial plexus blocks (coracoid approach); 1.5 mg/kg dose of bupivacaine and&#xD;
        1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position&#xD;
        under US guidance.&#xD;
  &#xD;
          -  The block will be applied only once, approximately 15-20 minutes before surgery.&#xD;
  &#xD;
          -  All patients will undergo electrocardiographic monitoring, oxygen saturation monitoring&#xD;
             with pulse oximetry and blood pressure measurement with automatic pneumatic manometer&#xD;
             before the application.&#xD;
  &#xD;
          -  Intravenous 1mg midazolam and 50 mcg fentanyl will be administered to all patients for&#xD;
             premedication before the procedure.&#xD;
  &#xD;
          -  The amount of medication to be given to all patients will be prepared as 1.5 mg/kg&#xD;
             bupivacaine and 1 mg/kg lidocaine.&#xD;
  &#xD;
          -  The prepared drug will be administered around the axillary artery at the appropriate&#xD;
             anatomical location determined under ultrasound guidance.&#xD;
  &#xD;
          -  Ultrasound device will be used as a supportive device during the application.&#xD;
  &#xD;
          -  The application will be performed by an anesthesiologist with at least 5 years of&#xD;
             experience.&#xD;
  &#xD;
          -  mode of delivery will be provided face to face and individually&#xD;
  &#xD;
          -  The administration will be only once, 20-30 minutes before the surgical procedure, with&#xD;
             a dose adjustment of 1.5 mg/kg bupivacaine and 1mg/kg lidocaine per kilogram of weight.&#xD;
  &#xD;
          -  The application will be made in the preoperative preparation room in the operating room&#xD;
             of the hospital where the surgery will be performed.&#xD;
  &#xD;
          -  The local anesthetic dose to be used in the application will be calculated according to&#xD;
             the weight of the patient. local anesthetics will be prepared by another&#xD;
             anesthesiologist in the preoperative preparation room just before the application.&#xD;
  &#xD;
          -  In the postoperative period, if the pain intensity (VAS) is &lt;4, 100 mg paracetamol will&#xD;
             be administered intravenously, if VAS = 4, 100 mg tramadol will be administered&#xD;
             intravenously&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Not yet recruiting</overall_status>
    <start_date type="Anticipated">September 11, 2023</start_date>
    <completion_date type="Anticipated">December 31, 2023</completion_date>
    <primary_completion_date type="Anticipated">December 29, 2023</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Randomized</allocation>
      <intervention_model>Parallel Assignment</intervention_model>
      <primary_purpose>Prevention</primary_purpose>
      <masking>Single (Participant)</masking>
    </study_design_info>
    <primary_outcome>
      <measure>Visual Analogue Scale (VAS)</measure>
      <time_frame>will be evaluated at 0, 4th, 8th, 12th, 14th, 16th, 18th, 24th hours postoperatively</time_frame>
      <description>The visual analog scale (VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between &quot;no pain&quot; and &quot;worst pain.&quot;&#xD;
  Pain intensity at the site of the operation.</description>
    </primary_outcome>
    <secondary_outcome>
      <measure>total amount of intravenous analgesics consumed</measure>
      <time_frame>will be evaluated at 0, 4th, 8th, 12th, 14th, 16th, 18th, 24th hours postoperatively</time_frame>
      <description>to be evaluated at the end of 24 hours postoperatively</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Sensory block start time</measure>
      <time_frame>The sensory block will be evaluated approximately 10 minutes after the application. It will be observed up to a maximum of 30 minutes.</time_frame>
      <description>The onset time of sensory block was defined as the time to reach an absence of hot-cold sensation in all 4 nerve distributions after completion of injection of the local anesthetic mixture.&#xD;
  Sensory block was assessed using the cold test on the dermatomes of the median, ulnar, radial and musculocutaneous nerves. Sensory block was graded on a 3-point scale (0: normal sensation, 1: analgesia [patient can feel touch but not cold], 2: anesthesia [patient cannot even feel touch]).</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>sensory block end time</measure>
      <time_frame>It will be evaluated every hour after the implementation, up to a maximum of 120 hours.</time_frame>
      <description>Sensory block end time: defined as the time when the hot-cold sensation disappears in all 4 nerve distributions after the injection of the local anesthetic mixture is completed.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Time to onset of motor block</measure>
      <time_frame>Motor block onset time will be assessed every 10 minutes after the intervention until 60 minutes.</time_frame>
      <description>Time to onset of motor block, the time from the completion of injection of the local anesthetic mixture until complete motor block develops (in case of bromage : 4).&#xD;
  Motor block was assessed with the Modified Bromage scale (scale 0: full flexion of the fingers, wrist and elbow; scale 1: full flexion of the fingers and wrist, but no flexion of the elbow); scale 2: full flexion of the fingers, but no flexion of the wrist and elbow; scale 3: complete motor block; no flexion of the fingers, wrist and elbow).</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Motor block end time</measure>
      <time_frame>It will be evaluated every hour after the implementation, up to a maximum of 120 hours.</time_frame>
      <description>Motor block was assessed with the Modified Bromage scale (scale 0: full flexion of the fingers, wrist and elbow; scale 1: full flexion of the fingers and wrist, but no flexion of the elbow); scale 2: full flexion of the fingers, but no flexion of the wrist and elbow; scale 3: complete motor block; no flexion of the fingers, wrist and elbow).&#xD;
  If the bromage is 0, the motor block will be considered as eliminated.</description>
    </secondary_outcome>
    <number_of_arms>3</number_of_arms>
    <enrollment type="Anticipated">159</enrollment>
    <condition>Forearm Surgery</condition>
    <arm_group>
      <arm_group_label>Group V (1726 meter altitude)</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>In the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance.&#xD;
  The block will be applied only once, approximately 15-20 minutes before surgery.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Group D (675 meter altitude)</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>In the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance.&#xD;
  The block will be applied only once, approximately 15-20 minutes before surgery.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Group H( 100 meter altitude)</arm_group_label>
      <arm_group_type>Active Comparator</arm_group_type>
      <description>In the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance.&#xD;
  The block will be applied only once, approximately 15-20 minutes before surgery.</description>
    </arm_group>
    <intervention>
      <intervention_type>Procedure</intervention_type>
      <intervention_name>Infraclavicular brachial plexus block</intervention_name>
      <description>In the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance.</description>
      <arm_group_label>Group D (675 meter altitude)</arm_group_label>
      <arm_group_label>Group H( 100 meter altitude)</arm_group_label>
      <arm_group_label>Group V (1726 meter altitude)</arm_group_label>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            -  Between 18-55 years old&#xD;
  &#xD;
            -  Body mass index between 20 and 25&#xD;
  &#xD;
            -  Patients with American Society of Anesthesiologists classification (ASA) physical&#xD;
               status I or II&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
            -  Patients aged younger than 18 and older than 55 years&#xD;
  &#xD;
            -  American Society of Anesthesiologists classification (ASA) ≥ III&#xD;
  &#xD;
            -  Body mass index (BMI) &gt;35&#xD;
  &#xD;
            -  Known history of allergy to local anesthetics preoperative chronic pain and therefore&#xD;
               long-term analgesic use&#xD;
  &#xD;
            -  In case of coagulopathy&#xD;
  &#xD;
            -  Have a condition that constitutes a contraindication for the application of the block&#xD;
               (local infection, sepsis, local anesthetic medicine allergy; severe neurological,&#xD;
               muscular or psychiatric disease, coagulation disorders)&#xD;
  &#xD;
            -  With marked cognitive impairment&#xD;
  &#xD;
            -  Patients who did not want to participate in the study.&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>18 Years</minimum_age>
      <maximum_age>55 Years</maximum_age>
      <healthy_volunteers>No</healthy_volunteers>
    </eligibility>
    <overall_official>
      <last_name>Cem K. Kaçar, Assoc.Prof</last_name>
      <role>Study Director</role>
      <affiliation>Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital</affiliation>
    </overall_official>
    <overall_contact>
      <last_name>Fatma Acil, M.D.</last_name>
      <phone>+905337225225</phone>
      <email>acilfatma@gmail.com</email>
    </overall_contact>
    <reference>
      <citation>Harmon D, Frizelle HP. Supraclavicular block for day-case anaesthesia at altitude. Anaesthesia. 2001 Feb;56(2):197. doi: 10.1046/j.1365-2044.2001.01870-30.x. No abstract available.</citation>
      <PMID>11167511</PMID>
    </reference>
    <verification_date>September 2023</verification_date>
    <study_first_submitted>August 29, 2023</study_first_submitted>
    <study_first_submitted_qc>September 5, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">September 7, 2023</study_first_posted>
    <last_update_submitted>September 14, 2023</last_update_submitted>
    <last_update_submitted_qc>September 14, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">September 18, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Principal Investigator</responsible_party_type>
      <investigator_affiliation>Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital</investigator_affiliation>
      <investigator_full_name>Fatma Acil</investigator_full_name>
      <investigator_title>Principal Investigator</investigator_title>
    </responsible_party>
    <patient_data>
      <sharing_ipd>Undecided</sharing_ipd>
    </patient_data>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT06027918
  org study id: 12.09.2022/266
  nct id: NCT06027918
  lead sponsor: 
  has dmc: No
  is fda regulated drug: No
  is fda regulated device: No
  Infraclavicular brachial plexus block in hand and forearm surgery has the advantages of high
        success rate and low risk of complications and is useful in providing long-lasting and
        effective postoperative analgesia in these patients. In response to hypoxemia at high
        altitude, increased blood viscosity, decreased carbon monoxide diffusion capacity, increased
        cerebral arterial blood flow, decreased blood volume and decreased cardiac output occur. At
        high altitude, the serum level of local anesthetics may increase due to an increase in their
        ionized fraction and a decrease in their clearance. In this respect, the pharmacodynamic and
        pharmacokinetic properties of peripheral nerve blocks may be altered when performed at high
        altitude. The primary objective of this prospective study was to test the hypothesis that
        postoperative pain scores are higher in patients undergoing infraclavicular nerve block at
        high altitude than in patients at low altitude.
  
        This multicenter prospective randomized study will be initiated after approval of the Ethics
        Committee of Health ScienceUniversity Diyarbakir Gazi Yasargil Training and Research
        Hospital. Patients will be recruited simultaneously in 3 hospitals, Hatay Training and
        Research Hospital, Hatay, Turkey (100 m above sea level);Health Science Health Science
        University Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey (675 m
        above sea level) and Health Science University Van Regional and Training Research Hospital,
        Van, Turkey (1726 m above sea level).
  
        Infraclavicular brachial plexus blocks (coracoid approach) will be performed by administering
        a local anesthetic mixture of 1.5 mg/kg lidocaine 2% + 1 mg/kg bupivacaine 0.5% at the 6
        o'clock position of the axillary artery under US guidance.
  Group V (1726 meter altitude): In the application of infraclavicular brachial plexus blocks
        (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be
        applied around the axillary artery in the 6 o'clock position under US guidance.
  
          -  The block will be applied only once, approximately 15-20 minutes before surgery.
  
          -  All patients will undergo electrocardiographic monitoring, oxygen saturation monitoring
             with pulse oximetry and blood pressure measurement with automatic pneumatic manometer
             before the application.
  
          -  Intravenous 1mg midazolam and 50 mcg fentanyl will be administered to all patients for
             premedication before the procedure.
  
          -  The amount of medication to be given to all patients will be prepared as 1.5mg/kg
             bupivacaine and 1mg/kg lidocaine.
  
          -  The prepared drug will be administered around the axillary artery at the appropriate
             anatomical location determined under ultrasound guidance.
  
          -  Ultrasound device will be used as a supportive device during the application.
  
          -  The application will be performed by an anesthesiologist with at least 5 years of
             experience.
  
          -  mode of delivery will be provided face to face and individually
  
          -  The administration will be only once, 20-30 minutes before the surgical procedure, with
             a dose adjustment of 1.5mg/kg bupivacaine and 1mg/kg lidocaine per kilogram of weight.
  
          -  The application will be made in the preoperative preparation room in the operating room
             of the hospital where the surgery will be performed.
  
          -  The local anesthetic dose to be used in the application will be calculated according to
             the weight of the patient. local anesthetics will be prepared by another
             anesthesiologist in the preoperative preparation room just before the application.
  
          -  In the postoperative period, if the pain intensity (VAS) is <4, 100 mg paracetamol will
             be administered intravenously, if VAS = 4, 100 mg tramadol will be administered
             intravenously
  
        Group D (675 meter altitude): In the application of infraclavicular brachial plexus blocks
        (coracoid approach); 1.5 mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be
        applied around the axillary artery in the 6 o'clock position under US guidance.
  
          -  The block will be applied only once, approximately 15-20 minutes before surgery.
  
          -  All patients will undergo electrocardiographic monitoring, oxygen saturation monitoring
             with pulse oximetry and blood pressure measurement with automatic pneumatic manometer
             before the application.
  
          -  Intravenous 1mg midazolam and 50 mcg fentanyl will be administered to all patients for
             premedication before the procedure.
  
          -  The amount of medication to be given to all patients will be prepared as 1.5 mg/kg
             bupivacaine and 1mg/kg lidocaine.
  
          -  The prepared drug will be administered around the axillary artery at the appropriate
             anatomical location determined under ultrasound guidance.
  
          -  Ultrasound device will be used as a supportive device during the application.
  
          -  The application will be performed by an anesthesiologist with at least 5 years of
             experience.
  
          -  mode of delivery will be provided face to face and individually
  
          -  The administration will be only once, 20-30 minutes before the surgical procedure, with
             a dose adjustment of 1.5 mg/kg bupivacaine and 1mg/kg lidocaine per kilogram of weight.
  
          -  The application will be made in the preoperative preparation room in the operating room
             of the hospital where the surgery will be performed.
  
          -  The local anesthetic dose to be used in the application will be calculated according to
             the weight of the patient. local anesthetics will be prepared by another
             anesthesiologist in the preoperative preparation room just before the application.
  
          -  In the postoperative period, if the pain intensity (VAS) is <4, 100 mg paracetamol will
             be administered intravenously, if VAS = 4, 100 mg tramadol will be administered
             intravenously
  
        Comparator / control treatment Group H (100 meter altitude): In the application of
        infraclavicular brachial plexus blocks (coracoid approach); 1.5 mg/kg dose of bupivacaine and
        1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position
        under US guidance.
  
          -  The block will be applied only once, approximately 15-20 minutes before surgery.
  
          -  All patients will undergo electrocardiographic monitoring, oxygen saturation monitoring
             with pulse oximetry and blood pressure measurement with automatic pneumatic manometer
             before the application.
  
          -  Intravenous 1mg midazolam and 50 mcg fentanyl will be administered to all patients for
             premedication before the procedure.
  
          -  The amount of medication to be given to all patients will be prepared as 1.5 mg/kg
             bupivacaine and 1 mg/kg lidocaine.
  
          -  The prepared drug will be administered around the axillary artery at the appropriate
             anatomical location determined under ultrasound guidance.
  
          -  Ultrasound device will be used as a supportive device during the application.
  
          -  The application will be performed by an anesthesiologist with at least 5 years of
             experience.
  
          -  mode of delivery will be provided face to face and individually
  
          -  The administration will be only once, 20-30 minutes before the surgical procedure, with
             a dose adjustment of 1.5 mg/kg bupivacaine and 1mg/kg lidocaine per kilogram of weight.
  
          -  The application will be made in the preoperative preparation room in the operating room
             of the hospital where the surgery will be performed.
  
          -  The local anesthetic dose to be used in the application will be calculated according to
             the weight of the patient. local anesthetics will be prepared by another
             anesthesiologist in the preoperative preparation room just before the application.
  
          -  In the postoperative period, if the pain intensity (VAS) is <4, 100 mg paracetamol will
             be administered intravenously, if VAS = 4, 100 mg tramadol will be administered
             intravenously
  allocation: Randomized
  intervention model: Parallel Assignment
  primary purpose: Prevention
  masking: Single (Participant)
  measure: Visual Analogue Scale (VAS)
  time frame: will be evaluated at 0, 4th, 8th, 12th, 14th, 16th, 18th, 24th hours postoperatively
  description: The visual analog scale (VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between "no pain" and "worst pain."
  Pain intensity at the site of the operation.
  measure: total amount of intravenous analgesics consumed
  time frame: will be evaluated at 0, 4th, 8th, 12th, 14th, 16th, 18th, 24th hours postoperatively
  description: to be evaluated at the end of 24 hours postoperatively
  measure: Sensory block start time
  time frame: The sensory block will be evaluated approximately 10 minutes after the application. It will be observed up to a maximum of 30 minutes.
  description: The onset time of sensory block was defined as the time to reach an absence of hot-cold sensation in all 4 nerve distributions after completion of injection of the local anesthetic mixture.
  Sensory block was assessed using the cold test on the dermatomes of the median, ulnar, radial and musculocutaneous nerves. Sensory block was graded on a 3-point scale (0: normal sensation, 1: analgesia [patient can feel touch but not cold], 2: anesthesia [patient cannot even feel touch]).
  measure: sensory block end time
  time frame: It will be evaluated every hour after the implementation, up to a maximum of 120 hours.
  description: Sensory block end time: defined as the time when the hot-cold sensation disappears in all 4 nerve distributions after the injection of the local anesthetic mixture is completed.
  measure: Time to onset of motor block
  time frame: Motor block onset time will be assessed every 10 minutes after the intervention until 60 minutes.
  description: Time to onset of motor block, the time from the completion of injection of the local anesthetic mixture until complete motor block develops (in case of bromage : 4).
  Motor block was assessed with the Modified Bromage scale (scale 0: full flexion of the fingers, wrist and elbow; scale 1: full flexion of the fingers and wrist, but no flexion of the elbow); scale 2: full flexion of the fingers, but no flexion of the wrist and elbow; scale 3: complete motor block; no flexion of the fingers, wrist and elbow).
  measure: Motor block end time
  time frame: It will be evaluated every hour after the implementation, up to a maximum of 120 hours.
  description: Motor block was assessed with the Modified Bromage scale (scale 0: full flexion of the fingers, wrist and elbow; scale 1: full flexion of the fingers and wrist, but no flexion of the elbow); scale 2: full flexion of the fingers, but no flexion of the wrist and elbow; scale 3: complete motor block; no flexion of the fingers, wrist and elbow).
  If the bromage is 0, the motor block will be considered as eliminated.
  arm group label: Group V (1726 meter altitude)
  arm group type: Active Comparator
  description: In the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance.
  The block will be applied only once, approximately 15-20 minutes before surgery.
  arm group label: Group D (675 meter altitude)
  arm group type: Active Comparator
  description: In the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance.
  The block will be applied only once, approximately 15-20 minutes before surgery.
  arm group label: Group H( 100 meter altitude)
  arm group type: Active Comparator
  description: In the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance.
  The block will be applied only once, approximately 15-20 minutes before surgery.
  intervention type: Procedure
  intervention name: Infraclavicular brachial plexus block
  description: In the application of infraclavicular brachial plexus blocks (coracoid approach); 1.5mg/kg dose of bupivacaine and 1mg/kg lidocaine mixture will be applied around the axillary artery in the 6 o'clock position under US guidance.
  arm group label: Group D (675 meter altitude)
  arm group label: Group H( 100 meter altitude)
  arm group label: Group V (1726 meter altitude)
  criteria: 
  gender: All
  minimum age: 18 Years
  maximum age: 55 Years
  healthy volunteers: No
  last name: Cem K. Kaçar, Assoc.Prof
  role: Study Director
  affiliation: Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital
  last name: Fatma Acil, M.D.
  phone: +905337225225
  email: acilfatma@gmail.com
  citation: Harmon D, Frizelle HP. Supraclavicular block for day-case anaesthesia at altitude. Anaesthesia. 2001 Feb;56(2):197. doi: 10.1046/j.1365-2044.2001.01870-30.x. No abstract available.
  PMID: 11167511
  responsible party type: Principal Investigator
  investigator affiliation: Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital
  investigator full name: Fatma Acil
  investigator title: Principal Investigator
  sharing ipd: Undecided