Analgesia
Conditions
Brief summary
Post-tourniquet pain remains a common problem. It disturbs the quality of anesthesia during brachial plexus block for distal upper-limb surgery. Current evidence shows that adding an intercostobrachial nerve block using the landmark-based technique can improve analgesia for medial upper-arm procedures.
Detailed description
Post-tourniquet pain remains a common problem. It disturbs the quality of anesthesia during brachial plexus block for distal upper-limb surgery. Current evidence shows that adding an intercostobrachial nerve block using the landmark-based technique can improve analgesia for medial upper-arm procedures. The serratus anterior plane block has also been proposed as an adjunct that may cover the intercostobrachial nerve territory. However, the landmark intercostobrachial nerve technique relies on a blind injection and may give inconsistent results. Moreover, high-quality head-to-head data comparing ultrasound-guided intercostobrachial nerve block with serratus anterior plane block for tourniquet pain prevention are lacking.
Interventions
PROCEDURESelective ultrasound guided Intercostobrachial nerve block
The patient will be positioned supine with the ipsilateral arm abducted. The ultrasound transducer will be positioned in the axilla along the mid-axillary line to visualize the thoracodorsal artery and vein and the fascia between the latissimus dorsi and serratus anterior muscles. The Intercostobrachial nerve often appears as a small hyperechoic structure lateral to the thoracodorsal vessels.
PROCEDURESerratus anterior plane block
The ultrasound transducer will be placed at the mid-axillary line at the level of the fourth or fifth rib to identify and inject a local anaesthetic drug in the plane between the latissimus dorsi and serratus anterior muscles.
Sponsors
Zagazig University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 64 Years
Healthy volunteers
No
Inclusion criteria
* Elective unilateral distal upper-limb surgery (hand, wrist or forearm) with use of pneumatic upper-arm tourniquets under ultrasound-guided brachial plexus block.
Exclusion criteria
* Coagulopathy or therapeutic anticoagulation. * Local infection at injection sites. * Chronic opioid dependence.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Tourniquet pain degree | The first 60 minutes of tourniquet inflation. | The visual analogue score of tourniquet pain at the end of first 60 minutes of tourniquet inflation with score 10 indicates worst pain and score 0 indicates no pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of tourniquet application. | The first 2 hours intraoperative. | The time from tourniquet inflation to tourniquet deflation. |
Contacts
CONTACTMohamed Mohamed, MD
CONTACTAhmed Mohamed Hassan
STUDY_DIRECTORAmal Abdelazim Salah, MD
Department of Anesthesia, Intensive Care & Pain Management, Zagazig University
STUDY_CHAIROsama Abo Elfotouh Ismael Hassan, MD
Department of Anesthesia, Intensive Care & Pain Management, Zagazig University
Outcome results
None listed