Analgesic Effect of Supraclavicular Block and Interscalene Analgesia Versus an Intercostobrachial Nerve Block Versus PCA in Forearm Surgery

Al-Azhar University

Status and phase: Enrolling; Phase 4

Conditions: Forearm Surgery; Interscalene Analgesia; Tourniquet Pain; US-Guided Supraclavicular Block

Treatments: Drug: bupivacaine, midazolam

Study type: Interventional

Funder types: Other

Identifiers

NCT05602636

IRB 00012367-22-011-003

Details and patient eligibility

About

The etiology of tourniquet pain is complex, and the study team hypothesizes that blocking with Interscalene brachial plexus block (ISBPB) is more efficient in decreasing the incidence of tourniquet pain in comparison with other techniques.

As there is a paucity of studies that evaluate the effect of intercostobrachial nerve (ICBN) block and ISBPB and Patient-Controlled Analgesia (PCA) with a supraclavicular brachial plexus block (SCBPB) on tourniquet pain in forearm surgery, Therefore, we established this randomized study to compare ISBPB and ICBN and PCA with fentanyl with SCBPB in terms of the incidence and severity of tourniquet pain in patients undergoing forearm surgery.

Enrollment: 60 estimated patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• aged more than 18 years,
• ASAI-III patients
• scheduled to undergo orthopedic or plastic surgery distal to the elbow with an anticipated tourniquet duration greater than 45 min.
• desiring regional anesthesia as the primary anesthetic.

Exclusion criteria

• Contraindication to regional anesthesia.
• Allergy to local anesthetics.
• Primary block failure.
• If patients desired deep intraoperative sedation.
• Clinically significant cognitive impairment.

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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60 participants in 3 patient groups

interscalene analgesia (Group ISBPB)

Active Comparator group

Description:

All patients will receive a supraclavicular block as their primary anesthetic. Brachial plexus blocks will be performed at the supraclavicular fossa using 20 to 30 mL of 0.5% bupivacaine under ultrasound guidance. The C5 to C7 or C5 to C8 nerve roots between the anterior scalene and middle scalene muscles will be visualized in the absence of the subclavian artery and 10 mL 0.125% bupivacaine will be injected around the nerve roots of the brachial plexus. The needle trajectory will be adjusted to facilitate the even distribution of the local anesthetic around each nerve root.

Treatment:

Drug: bupivacaine, midazolam

The intercostobrachial nerve block ( Group ICBN)

Active Comparator group

Description:

All patients will receive a supraclavicular block as their primary anesthetic. Brachial plexus blocks will be performed at the supraclavicular fossa using 20 to 30 mL of 0.5% bupivacaine under ultrasound guidance. The ICBN block will be performed with 10 mL of 0.5% bupivacaine in the plane deep to the pectoralis minor and/or serratus anterior muscle over the second and third intercostal space.

Treatment:

Drug: bupivacaine, midazolam

Patient-Controlled Analgesia (Group PCA)

Active Comparator group

Description:

All patients will receive a supraclavicular block as their primary anesthetic. Brachial plexus blocks will be performed at the supraclavicular fossa using 20 to 30 mL of 0.5% bupivacaine under ultrasound guidance.

Treatment:

Drug: bupivacaine, midazolam