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Regional anesthesia decreases postoperative pain scores and opioid consumption, and may prevent chronic pain after surgery in patients undergoing surgery. However, some patients experience an increase of pain into the severe range when the nerve block wears off, also known as rebound pain. The investigators are studying if a nerve block (numbing injection) in the arm causes hyperalgesia (increased pain) when the nerve block is wearing off.
This is a prospective, randomized study in healthy volunteers who will undergo sensory testing using quantitative sensory testing (QST), complete psychosocial and pain questionnaires, and ultrasound-guided peripheral nerve block of the arm (axillary nerve block) in a supervised, monitored setting (BWH Clinical Investigation Center). The investigators plan to assess the association between different QST modalities at different time points pre- and post-nerve block resolution. Semi-structured interviews and qualitative analysis will be used to explore patient's experiences with nerve block placement.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Block upper extremity (arm) | Experimental | Upper extremity with a nerve block |
|
| Control upper extremity (arm) | No Intervention | Upper extremity without a nerve block |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Mepivacaine | Drug | Injection of 1.5% Mepivacaine in nerve block |
|
| Measure | Description | Time Frame |
|---|---|---|
| Heat pain detection threshold at time 1 hr | Heat pain detection threshold (°C) between block arm and control arm using a heat probe at 1 hour after nerve block resolution | 1 hour after nerve block resolution |
| Measure | Description | Time Frame |
|---|---|---|
| Heat pain detection threshold and tolerance | Heat pain detection threshold and tolerance (°C) between block arm and control arm using a heat probe at different time points up to 3 hours nerve block resolution | 0-3 hours after nerve block resolution |
| Pressure pain threshold and tolerance |
| Measure | Description | Time Frame |
|---|---|---|
| Temperature change | To observe the change in temperature between block arm and control arm (°C) pre, during, and post nerve block | 6-8 hours |
| Patient's experiences with nerve block | Semi-structured interviews will be used to explore patient's experiences with nerve block placement using an immersion/crystallization approach to identify emergent themes |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Yun-Yun K Chen, MD | Brigham and Women's Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Brigham and Women's Hospital | Boston | Massachusetts | 02115 | United States |
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| Label | URL |
|---|---|
| Mass General Brigham Rally Flyer | View source |
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| ID | Term |
|---|---|
| D059787 | Acute Pain |
| ID | Term |
|---|---|
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D008619 | Mepivacaine |
| D011318 | Prilocaine |
| ID | Term |
|---|---|
| D010880 | Piperidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D000813 | Anilides |
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Participants will be randomized to which arm will receive a nerve block.
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Pressure pain threshold and tolerance (N of force) between block arm and control arm using an algometer at different time points up to 3 hours nerve block resolution |
| 0-3 hours after nerve block resolution |
| Temporal summation and sharp pain | Temporal summation and sharp pain (evaluated by numerical rating scale 0-10 pain score) between block arm and control arm using a pinprick device at different time points up to 3 hours nerve block | 0-3 hours after nerve block resolution |
| Light touch detection | Light touch detection (mN of force) between block arm and control arm using von Frey filaments at different time points up to 3 hours nerve block | 0-3 hours after nerve block resolution |
| Light touch pain threshold | Light touch pain threshold (mN of force) between block arm and control arm using von Frey filaments at different time points up to 3 hours nerve block | 0-3 hours after nerve block resolution |
| 6-8 hours |
| Pain catastrophizing and gender differences | Correlation between situational pain catastrophizing (0-24 scale) and gender | 6-8 hours |
| D000577 |
| Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |