Nerve Block, Pain
Conditions
Keywords
Intercostobrachial Nerve Block, Tourniquet Pain, Upper Limb Surgeries
Brief summary
In this study the investigators would like to show that when patients undergo upper limb surgery under supraclavicular brachial plexus block, additional blocking of the Intercostobrachial Nerve Block (ICBN) does not affect the incidence or course of tourniquet pain.
Detailed description
The ICBN is a cutaneous sensory nerve that supplies the medial aspect of the upper arm. Traditionally this nerve is blocked to alleviate tourniquet pain. The etiology of tourniquet pain is complex and the study team hypothesize that blocking the ICBN has no impact on tourniquet pain. Patients will receive a supraclavicular block and be divided into two groups; ICBN with local anesthetic or ICBN with saline. All patients in this study will receive a supraclavicular block as their primary anesthetic and then be divided into two groups; those who receive ICBN and those who do not. Amount of intraoperative analgesics, conversion to deep sedation or general anesthesia, and onset of time to tourniquet pain will be the primary measures of this study.
Interventions
DRUGReceive ICBN with ropivacaine
ICBN block will be performed using US guidance depositing 10 ml of 0.5% ropivacaine in the plane between pectoralis minor and serratus anterior over the 2nd and 3rd intercostal space.
BEHAVIORALNo ICBN block
The site of injection will be prepped with tinted chlorhexidine
Sponsors
University of Florida
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
DOUBLE (Subject, Caregiver)
Masking description
In order to blind anesthesia providers in the room and nurses in Post-op Anesthesia Care Unit (PACU), the site of injection for ICBN will be prepped with tinted chlorhexidine in all patients.
Intervention model description
Patients will be randomized to receive ICBN with ropivacaine or no ICBN or ropivacaine.
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists (ASA) 1-3 * Distal upper extremity surgery with anticipated use of tourniquet * Outpatient surgery * Patients who desire regional anesthesia as primary anesthetic
Exclusion criteria
* ASA 4 or greater * Allergies to local anesthetic * Refusal of regional anesthesia * History of chronic pain syndromes * Patients who do not desire regional anesthesia as primary anesthetic
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change between the 2 groups assessed by the incidence of tourniquet pain reported by the patient on a Descriptor Differential Scale of Pain Intensity (DDSI) | From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours) | Tourniquet pain defined by the presence of dull or aching pain underneath the tourniquet |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change between the 2 groups depth of anesthesia during surgery to alleviate tourniquet pain as assessed by the American Society of Anesthesiologist (ASA) Continuum of Depth of Sedation definition of general anesthesia and levels of sedation/analgesia. | From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours) | Determine required depth of anesthesia during surgery to alleviate tourniquet pain |
| Change between the 2 groups assessed by intraoperative opioid consumption | From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours) | Determine amount of intraoperative opioid consumption due to tourniquet pain |
| Change between the 2 groups assessed by time to onset of tourniquet pain | From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours) | Determine the time to onset of tourniquet pain |
| Change between the 2 groups in reported severity of tourniquet pain | From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours) | Determine if ICBN has an affect on the severity of tourniquet pain as assessed by Descriptor Differential Scale of Pain Intensity (DDSI) There are 10 points along which patients can rate their pain intensity to the right and left of each descriptor, so the pain is rated on a 21 point scale for each descriptor. Pain intensity is defined as a mean of the ratings and can range from 0 to 20. |
Countries
United States
Outcome results
None listed