Tourniquet Pain Prevention During Distal Upper Limb Surgery

Brachial Plexus With Intercostobrachial Nerve or Serratus Anterior Plane Block for Tourniquet Pain Prevention During Distal Upper-Limb Surgery

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.

Study Overview

• Status: Not yet recruiting
• Conditions: Analgesia
• Intervention / Treatment: Procedure: Selective ultrasound guided Intercostobrachial nerve block; Procedure: Serratus anterior plane block

Detailed Description

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
• Enrollment (Estimated): 90
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Mohamed Mohamed, MD; Phone Number: 01 203350873; Email: mgmelsayed@medicine.zu.edu.eg
• Study Contact Backup: Name: Ahmed Mohamed Hassan; Phone Number: +20 11 13930038

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Elective unilateral distal upper-limb surgery (hand, wrist or forearm) with use of pneumatic upper-arm tourniquets under ultrasound-guided brachial plexus block.

Exclusion Criteria:

• Coagulopathy or therapeutic anticoagulation.
• Local infection at injection sites.
• Chronic opioid dependence.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Selective ultrasound guided Intercostobrachial nerve block; After a brachial plexus block, participants will receive a selective Intercostobrachial nerve block. 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.	Procedure: Selective ultrasound guided Intercostobrachial nerve block; 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.
Active Comparator: Serratus anterior plane block; The patient will be positioned supine with the ipsilateral arm abducted slightly. Under aseptic conditions, the ultrasound transducer will be placed at the mid-axillary line at the level of the fourth or fifth rib to identify the plane between the latissimus dorsi and serratus anterior muscles.	Procedure: Serratus anterior plane block; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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.	The first 60 minutes of tourniquet inflation.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Duration of tourniquet application.	The time from tourniquet inflation to tourniquet deflation.	The first 2 hours intraoperative.

Collaborators and Investigators

• Sponsor: Zagazig University
• Investigators: Study Director: Amal Abdelazim Salah, MD, Department of Anesthesia, Intensive Care & Pain Management, Zagazig University; Study Chair: Osama Abo Elfotouh Ismael Hassan, MD, Department of Anesthesia, Intensive Care & Pain Management, Zagazig University

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2026
• Primary Completion (Estimated): February 1, 2027
• Study Completion (Estimated): March 1, 2027

Study Registration Dates

• First Submitted: August 21, 2026
• First Submitted That Met QC Criteria: August 21, 2026
• First Posted (Actual): August 25, 2026

Study Record Updates

• Last Update Posted (Actual): August 27, 2026
• Last Update Submitted That Met QC Criteria: August 25, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Perceptual Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Agnosia
• Other Study ID Numbers: Tourniquet Pain Management

Drug and device information, study documents

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