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

Early Phase 1

Completed

Interventions: Drug: Receive ICBN with ropivacaine
Behavioral: No ICBN block

Brief Summary: 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.

Detailed Description: 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.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
ICBN with ropivacaine	Receive ICBN with ropivacaine	Participants will receive ICBN with ropivacaine. In order to blind anesthesia providers in the room and nurses in PACU, the site of injection for ICBN will be prepped with tinted chlorhexidine in all patients.
No ICBN block	No ICBN block	Participants will have the site prepped, but no ICBN block given. In order to blind anesthesia providers in the room and nurses in PACU, the site of injection for ICBN will be prepped with tinted chlorhexidine in all patients.

Primary Outcome Measures

Name	Time	Method
Change between the 2 groups assessed by the incidence of tourniquet pain reported by the patient on a Descriptor Differential Scale of Pain Intensity (DDSI)	From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours)	Tourniquet pain defined by the presence of dull or aching pain underneath the tourniquet

Secondary Outcome Measures

Name	Time	Method
Change between the 2 groups depth of anesthesia during surgery to alleviate tourniquet pain as assessed by the American Society of Anesthesiologist (ASA) Continuum of Depth of Sedation definition of general anesthesia and levels of sedation/analgesia.	From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours)	Determine required depth of anesthesia during surgery to alleviate tourniquet pain
Change between the 2 groups assessed by intraoperative opioid consumption	From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours)	Determine amount of intraoperative opioid consumption due to tourniquet pain
Change between the 2 groups assessed by time to onset of tourniquet pain	From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours)	Determine the time to onset of tourniquet pain
Change between the 2 groups in reported severity of tourniquet pain	From intraoperative pre tourniquet insufflation to intraoperative release of tourniquet (up to 2 hours)	Determine if ICBN has an affect on the severity of tourniquet pain as assessed by Descriptor Differential Scale of Pain Intensity (DDSI) There are 10 points along which patients can rate their pain intensity to the right and left of each descriptor, so the pain is rated on a 21 point scale for each descriptor. Pain intensity is defined as a mean of the ratings and can range from 0 to 20.