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Successful peripheral nerve blockade is fundamental to modern regional anesthesia, particularly for upper limb surgeries. Ensuring the efficacy of a nerve block early in the perioperative period is critical, as delayed recognition of block failure may lead to intraoperative pain, the need for additional sedation or general anesthesia, and overall poorer patient outcomes. Conventional methods for assessing block success, such as sensory testing with pinprick or cold stimuli and motor assessment using strength scales, require patient cooperation and often take 15-30 minutes to yield definitive results. These delays are especially limiting in fast-paced surgical environments or when early decisions regarding anesthesia management are necessary.
Emerging non-invasive monitoring technologies offer promising alternatives for the early, objective assessment of block efficacy. Infrared Thermography (IRT) measures skin surface temperature, which increases due to sympathetic nerve blockade-induced vasodilation.
Successful peripheral nerve blockade is fundamental to modern regional anesthesia, particularly for upper limb surgeries. Ensuring the efficacy of a nerve block early in the perioperative period is critical, as delayed recognition of block failure may lead to intraoperative pain, the need for additional sedation or general anesthesia, and overall poorer patient outcomes. Conventional methods for assessing block success, such as sensory testing with pinprick or cold stimuli and motor assessment using strength scales, require patient cooperation and often take 15-30 minutes to yield definitive results. These delays are especially limiting in fast-paced surgical environments or when early decisions regarding anesthesia management are necessary.
Emerging non-invasive monitoring technologies offer promising alternatives for early, objective assessment of block efficacy. Infrared Thermography (IRT) measures skin surface temperature, which increases with sympathetic nerve blockade-induced vasodilation. Perfusion Index (PI), derived from pulse oximetry, reflects peripheral perfusion and also rises as vascular tone decreases following a successful nerve block. Both IRT and PI provide quantifiable, real-time physiological markers of sympathetic and circulatory changes that precede full sensory or motor blockade. Although several studies support their individual utility, there is limited evidence on their combined predictive value or their integration into routine clinical practice. Further investigation is needed to validate their role in enhancing the accuracy and timeliness of block assessment.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Supraclavicular Brachial Plexus Block with Thermographic and Perfusion Monitoring | Experimental | Participants will receive an ultrasound-guided supraclavicular brachial plexus block using 30 mL of 0.5% bupivacaine for upper limb surgery. Infrared thermography and perfusion index measurements will be recorded at baseline, and at 5, 10, and 15 minutes post-block to detect early physiological changes. Clinical assessment of sensory and motor block will be performed at 20 minutes post-injection using standardized testing. The goal is to evaluate the predictive accuracy of these non-invasive measures in detecting block success or failure. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ultrasound-Guided Supraclavicular Block | Procedure | Ultrasound-guided supraclavicular brachial plexus block using a high-frequency linear ultrasound probe-real-time visualization of the brachial plexus for precise anesthetic delivery. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Skin Temperature (°C) Measured by Infrared Thermography From Baseline to 10 Minutes Post-block. | Mean change in skin temperature on the operative limb captured using infrared thermography at defined time points. | Baseline, 5, and 10 minutes post-injection |
| Change in Perfusion Index From Baseline to 10 Minutes Post-block | PI measured via pulse oximeter; change calculated as ratio to baseline values. | Baseline, 5, and 10 minutes post-injection |
| Measure | Description | Time Frame |
|---|---|---|
| Correlation Between Changes in Skin Temperature and Perfusion Index With Sensory and Motor Block Scores at 20 Minutes | Correlation between physiologic changes and clinical assessments of sensory and motor block success using pinprick/cold test and Modified Bromage Scale. | 20 minutes post-injection |
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Tarek Ashraf Ibrahim Abd Al-Hafiz, resident doctor | Contact | +201092002284 | tarek.15235463@med.aun.edu.eg |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37323293 | Background | Gamal M, Hasanin A, Adly N, Mostafa M, Yonis AM, Rady A, Abdallah NM, Ibrahim M, Elsayad M. Thermal Imaging to Predict Failed Supraclavicular Brachial Plexus Block: A Prospective Observational Study. Local Reg Anesth. 2023 Jun 9;16:71-80. doi: 10.2147/LRA.S406057. eCollection 2023. | |
| 28854539 | Background | Abdelnasser A, Abdelhamid B, Elsonbaty A, Hasanin A, Rady A. Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index. Br J Anaesth. 2017 Aug 1;119(2):276-280. doi: 10.1093/bja/aex166. |
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| Bupivacaine Hydrochloride 0.5 % Injectable Solution | Drug | 30 mL used for supraclavicular brachial plexus block |
|
| Ultrasound | Device | Imaging for block placement |
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| Infrared Thermography Camera | Device | Skin temperature monitoring |
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| Pulse Oximeter | Device | Perfusion Index monitoring |
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| ID | Term |
|---|---|
| D002045 | Bupivacaine |
| D014463 | Ultrasonography |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |
| D003952 | Diagnostic Imaging |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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