Tourniquet Pain Prevention During Distal Upper Limb Surgery

Brachial Plexus With Intercostobrachial Nerve or Serratus Anterior Plane Block for Tourniquet Pain Prevention During Distal Upper-Limb Surgery

Post-tourniquet pain remains a common problem. It disturbs the quality of anesthesia during brachial plexus block for distal upper-limb surgery. Current evidence shows that adding an intercostobrachial nerve block using the landmark-based technique can improve analgesia for medial upper-arm procedures.

Post-tourniquet pain remains a common problem. It disturbs the quality of anesthesia during brachial plexus block for distal upper-limb surgery. Current evidence shows that adding an intercostobrachial nerve block using the landmark-based technique can improve analgesia for medial upper-arm procedures. The serratus anterior plane block has also been proposed as an adjunct that may cover the intercostobrachial nerve territory. However, the landmark intercostobrachial nerve technique relies on a blind injection and may give inconsistent results. Moreover, high-quality head-to-head data comparing ultrasound-guided intercostobrachial nerve block with serratus anterior plane block for tourniquet pain prevention are lacking.

Inclusion Criteria:

• Elective unilateral distal upper-limb surgery (hand, wrist or forearm) with use of pneumatic upper-arm tourniquets under ultrasound-guided brachial plexus block.

Exclusion Criteria:

• Coagulopathy or therapeutic anticoagulation.
• Local infection at injection sites.
• Chronic opioid dependence.