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.
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
DOUBLE
Enrollment
46
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.
The site of injection will be prepped with tinted chlorhexidine
University of Florida
Gainesville, Florida, United States
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)
Tourniquet pain defined by the presence of dull or aching pain underneath the tourniquet
Time frame: From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours)
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.
Determine required depth of anesthesia during surgery to alleviate tourniquet pain
Time frame: From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours)
Change between the 2 groups assessed by intraoperative opioid consumption
Determine amount of intraoperative opioid consumption due to tourniquet pain
Time frame: From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours)
Change between the 2 groups assessed by time to onset of tourniquet pain
Determine the time to onset of tourniquet pain
Time frame: From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours)
Change between the 2 groups in reported severity of tourniquet pain
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.
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Time frame: From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours)