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

Comparison of Sympathetic Block Duration and Rebound Sympathetic Activity Rate in Infraclavicular and Supraclavicular Brachial Plexus Blocks Using Perfusion Index and Skin Temperature

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 Overview

• Status: Completed
• Conditions: Brachial Plexus Blockade; Anesthesia, Conduction; Sympathetic Blockade
• Intervention / Treatment: Procedure: Supraclavicular brachial plexus block; Procedure: Infraclavicular brachial plexus block

• Study Type: Interventional
• Enrollment (Actual): 200
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • İzmir
    • Izmir, İzmir, Turkey (Türkiye), 35030
      • Bozyaka Training and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Supraclavicular brachial plexus block	Procedure: Supraclavicular brachial plexus block; 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.
Active Comparator: Infraclavicular brachial plexus block	Procedure: Infraclavicular brachial plexus block; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Difference in duration of sympathetic blockade after different US-guided brachial plexus blocks	Twenty-four hours after nerve blockage

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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.	Twenty-four hours after nerve blockage

Collaborators and Investigators

• Sponsor: Bozyaka Training and Research Hospital

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2023
• Primary Completion (Actual): September 1, 2023
• Study Completion (Actual): September 2, 2023

Study Registration Dates

• First Submitted: April 10, 2023
• First Submitted That Met QC Criteria: January 3, 2026
• First Posted (Actual): January 8, 2026

Study Record Updates

• Last Update Posted (Actual): January 8, 2026
• Last Update Submitted That Met QC Criteria: January 3, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: skin temperature; perfusion index; infraclavicular brachial plexus block; supraclavicular brachial plexus block; sympathetic blockade
• Other Study ID Numbers: Brachial Plexus Block

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No