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This prospective comparative study will evaluate the sympathetic effects of ultrasound-guided infraclavicular versus supraclavicular brachial plexus blocks in adults undergoing upper-extremity surgery. Sympathetic tone will be monitored noninvasively with simultaneous bilateral measurements of perfusion index (pulse-oximetry-derived) and skin temperature obtained at baseline and at predefined post-block intervals until return to baseline. The primary outcome is the duration of sympathetic block. Secondary outcomes are between-approach differences in the time course of perfusion index and skin temperature, and the incidence and magnitude of rebound sympathetic activity.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Supraclavicular brachial plexus block | Active Comparator |
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| Infraclavicular brachial plexus block | Active Comparator |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Supraclavicular brachial plexus block | Procedure | A linear US probe (7-13 MHz) will be placed in the supraclavicular area in the coronal oblique plane, in-plane technique will be used, and after antisepsis of the area to be blocked, injection will be performed from lateral to medial direction using a 22G 50 mm stimulator needle (Stimuplex A®: B. Braun Melsungen AG, Japan). Intermittent negative aspiration will be performed during all procedures to detect possible vascular puncture. A total of 30 mL of 2% prilocaine containing 0.5% bupivacaine and 5 mcg/mL adrenaline in a 1:1 ratio will be used as local anesthetic. |
| Measure | Description | Time Frame |
|---|---|---|
| Difference in duration of sympathetic blockade after different US-guided brachial plexus blocks | Twenty-four hours after nerve blockage |
| Measure | Description | Time Frame |
|---|---|---|
| Change in perfusion index between infraclavicular and supraclavicular approaches | The perfusion index measured by pulse oximetry will be recorded at baseline and twenty-four hours after brachial plexus block. The outcome measure is defined as the change in perfusion index value between the two time points and compared between block approaches. | Twenty-four hours after nerve blockage |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Bozyaka Training and Research Hospital | Izmir | İzmir | 35030 | Turkey (Türkiye) |
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| Infraclavicular brachial plexus block | Procedure | A linear US probe (7-13 MHz) will be placed in the infraclavicular area through a lateral sagittal approach, in plane technique will be used and injection will be performed using a 22G 100 mm stimulator needle (Stimuplex A®: B. Braun Melsungen AG, Japan) after antisepsis of the area to be blocked. Intermittent negative aspiration will be performed during all procedures to detect possible vascular puncture. A total of 30 mL of 2% prilocaine containing 0.5% bupivacaine and 5 mcg/mL adrenaline in a 1:1 ratio will be used as local anesthetic. |
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