Comparison of Sympathetic Blockade Duration in Brachial Plexus Blocks Performed by Different Methods

Bozyaka Training and Research Hospital200 enrolled

Overview

This prospective comparative study will evaluate the sympathetic effects of ultrasound-guided infraclavicular versus supraclavicular brachial plexus blocks in adults undergoing upper-extremity surgery. Sympathetic tone will be monitored noninvasively with simultaneous bilateral measurements of perfusion index (pulse-oximetry-derived) and skin temperature obtained at baseline and at predefined post-block intervals until return to baseline. The primary outcome is the duration of sympathetic block. Secondary outcomes are between-approach differences in the time course of perfusion index and skin temperature, and the incidence and magnitude of rebound sympathetic activity.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Enrollment

200

Conditions

Anesthesia, Conduction Brachial Plexus Blockade Sympathetic Blockade

Interventions

Supraclavicular brachial plexus blockPROCEDURE

A linear US probe (7-13 MHz) will be placed in the supraclavicular area in the coronal oblique plane, in-plane technique will be used, and after antisepsis of the area to be blocked, injection will be performed from lateral to medial direction using a 22G 50 mm stimulator needle (Stimuplex A®: B. Braun Melsungen AG, Japan). Intermittent negative aspiration will be performed during all procedures to detect possible vascular puncture. A total of 30 mL of 2% prilocaine containing 0.5% bupivacaine and 5 mcg/mL adrenaline in a 1:1 ratio will be used as local anesthetic.

Infraclavicular brachial plexus blockPROCEDURE

A linear US probe (7-13 MHz) will be placed in the infraclavicular area through a lateral sagittal approach, in plane technique will be used and injection will be performed using a 22G 100 mm stimulator needle (Stimuplex A®: B. Braun Melsungen AG, Japan) after antisepsis of the area to be blocked. Intermittent negative aspiration will be performed during all procedures to detect possible vascular puncture. A total of 30 mL of 2% prilocaine containing 0.5% bupivacaine and 5 mcg/mL adrenaline in a 1:1 ratio will be used as local anesthetic.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18 to 65 year old * ASA I-II * Patients scheduled for upper extremity surgery * Fully oriented and able to cooperate * Patients who signed the informed consent form and gave consent to participate in the study Exclusion Criteria: * ASA III-IV-V * Non-cooperation * Disease that interferes with sensory block assessment * Known allergy to the medicines to be used * Pregnant patients * Coagulopathy or thrombocytopenia * Patients with anatomical abnormalities or active infection at the points of application

Outcomes

Primary Outcomes

Difference in duration of sympathetic blockade after different US-guided brachial plexus blocks

Time frame: Twenty-four hours after nerve blockage

Secondary Outcomes

Change in perfusion index between infraclavicular and supraclavicular approaches

The perfusion index measured by pulse oximetry will be recorded at baseline and twenty-four hours after brachial plexus block. The outcome measure is defined as the change in perfusion index value between the two time points and compared between block approaches.