Intercostobrachial Nerve Block (ICBN) for Tourniquet Pain: Is it Necessary?

Intercostobrachial Nerve Block (ICBN) for Tourniquet Pain: Is it Necessary?

In this study the investigators would like to show that when patients undergo upper limb surgery under supraclavicular brachial plexus block, additional blocking of the Intercostobrachial Nerve Block (ICBN) does not affect the incidence or course of tourniquet pain.

The ICBN is a cutaneous sensory nerve that supplies the medial aspect of the upper arm. Traditionally this nerve is blocked to alleviate tourniquet pain. The etiology of tourniquet pain is complex and the study team hypothesize that blocking the ICBN has no impact on tourniquet pain. Patients will receive a supraclavicular block and be divided into two groups; ICBN with local anesthetic or ICBN with saline. All patients in this study will receive a supraclavicular block as their primary anesthetic and then be divided into two groups; those who receive ICBN and those who do not. Amount of intraoperative analgesics, conversion to deep sedation or general anesthesia, and onset of time to tourniquet pain will be the primary measures of this study.

Inclusion Criteria:

• American Society of Anesthesiologists (ASA) 1-3
• Distal upper extremity surgery with anticipated use of tourniquet
• Outpatient surgery
• Patients who desire regional anesthesia as primary anesthetic

Exclusion Criteria:

• ASA 4 or greater
• Allergies to local anesthetic
• Refusal of regional anesthesia
• History of chronic pain syndromes
• Patients who do not desire regional anesthesia as primary anesthetic