Classic Versus Interfascial Axillary Block in Hand, Wrist, and Forearm Surgery

September 14, 2026 updated by: Korgün Ökmen, Bursa Yuksek Ihtisas Training and Research Hospital

Comparison of Axillary Block and Interfascial Axillary Block in Terms of Block Success and Intraoperative Clinical Efficacy in Hand, Wrist, and Forearm Surgery: A Prospective Randomized Study

Hand, wrist, and forearm surgeries are commonly performed procedures with significant postoperative pain potential. Regional anesthesia of the brachial plexus via the axillary approach is one of the gold-standard techniques for distal upper-limb surgery. In the conventional (classic) axillary block, the median, ulnar, and radial nerves within the axillary sheath are individually targeted under ultrasound guidance; however, anatomical septations around the axillary artery may prevent homogeneous spread of local anesthetic, leading to a patchy block and reduced intraoperative success.

The interfascial axillary block is a modified approach in which local anesthetic is deposited into the fascial planes between the axillary muscles rather than directly into the nerve sheath, aiming for passive diffusion, homogeneous spread, and fewer needle manipulations. This prospective, randomized, single-center study compares the classic axillary block with the interfascial axillary block in patients undergoing hand, wrist, and forearm surgery, primarily in terms of surgical anesthesia adequacy (block success).

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

This is a prospective, randomized, single-center clinical trial conducted in a Department of Anesthesiology and Reanimation. Randomization is performed using the sealed-envelope method. A total of 110 patients (55 per group) aged 18-90 years, American society of anesthesiologists physical status I-III, scheduled for elective hand, wrist, or forearm surgery under ultrasound-guided regional anesthesia will be enrolled.

Group 1 (Classic Axillary Block) receives an ultrasound-guided block targeting the median, ulnar, and radial nerves perineurally/perivascularly within the axillary sheath. Group 2 (Interfascial Axillary Block) receives an ultrasound-guided injection of local anesthetic into the potential fascial planes between the axillary muscles, relying on passive diffusion.

The primary outcome is surgical anesthesia adequacy (block success). Secondary outcomes include block application time, sensory and motor block onset, rates of additional local infiltration and conversion to general anesthesia, intraoperative additional analgesic/sedation requirements, hemodynamic parameters, patient and surgeon satisfaction, and complications.

Study Type

Interventional

Enrollment (Estimated)

110

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Turkey (Türkiye)
      • Bursa, Turkey (Türkiye), 16110
        • Bursa Yuksek Ihtisas Training and Research Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Aged 18-90 years
  • American society of anesthesiologists physical status I-II-III
  • Scheduled for elective hand, wrist, or forearm surgery
  • Written informed consent obtained

Exclusion Criteria:

  • History of local anesthetic allergy
  • Coagulation disorder
  • BMI > 40 kg/m²
  • Infection at the block site
  • Chronic pain syndrome
  • Pregnancy
  • Inability to communicate
  • Need for emergency surgery

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Classic Axillary Block
Ultrasound-guided classic axillary brachial plexus block. The median, ulnar, and radial nerves within the axillary sheath around the axillary artery are targeted individually by perineural/perivascular injection of local anesthetic.
Procedure: Classic Axillary Block
Classic (perivascular/perineural) axillary brachial plexus block
Active Comparator: Interfascial Axillary Block
Ultrasound-guided interfascial axillary block. Local anesthetic is injected into the potential fascial planes between the axillary muscles rather than directly into the nerve sheath, allowing passive diffusion of the drug.
Procedure: Interfascial Axillary Block
Interfascial (fascial-plane) axillary brachial plexus block.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Surgical anesthesia adequacy (block success)
Time Frame: 30 minutes after block
Complete sensory and motor blockade of the surgical field, allowing the operation to be completed without additional local infiltration or conversion to general anesthesia
30 minutes after block

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Block application time
Time Frame: intraoperative
time from needle insertion to withdrawal.
intraoperative
Sensory block onset time
Time Frame: 5., 10., 15., 30. minutes
Pin-Prick test in the median, ulnar, radial, and musculocutaneous dermatomes (0: normal, 1: blunt, 2: no sensation).
5., 10., 15., 30. minutes
Motor block onset time
Time Frame: 5., 10., 15., 30. minutes
5., 10., 15., 30. minutes
Intraoperative additional analgesic/sedation consumption
Time Frame: intraoperative
intraoperative
Patient and surgeon satisfaction
Time Frame: end of surgery
4-point Likert scale (1: very poor, 4: very good)
end of surgery

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Bursa Yuksek Ihtisas Training and Research Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

October 15, 2026

Primary Completion (Estimated)

September 15, 2027

Study Completion (Estimated)

September 30, 2027

Study Registration Dates

First Submitted

September 9, 2026

First Submitted That Met QC Criteria

September 14, 2026

First Posted (Actual)

September 16, 2026

Study Record Updates

Last Update Posted (Actual)

September 16, 2026

Last Update Submitted That Met QC Criteria

September 14, 2026

Last Verified

September 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • BursaYIEAH-2026-1

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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