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.
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
90
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.
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.
Tourniquet pain degree
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.
Time frame: The first 60 minutes of tourniquet inflation.
Duration of tourniquet application.
The time from tourniquet inflation to tourniquet deflation.
Time frame: The first 2 hours intraoperative.
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