Efficacy of Combined US-Guided Supraclavicular Block and Interscalene Analgesia Versus an Intercostobrachial Nerve Block Versus PCA With Fentanyl on Preventing Tourniquet Pain in Forearm Surgery: A Randomized Clinical Trial

What this Trial Is About

Researchers are comparing different nerve block techniques and patient-controlled analgesia to reduce tourniquet pain during forearm surgery. The trial focuses on the effectiveness of interscalene brachial plexus block (ISBPB), intercostobrachial nerve (ICBN) block, and supraclavicular brachial plexus block (SCBPB) combined with fentanyl for pain control. This randomized study aims to better understand which method lowers the incidence and severity of pain caused by a tourniquet used during surgery. All participants will receive a supraclavicular block as their primary anesthetic using 20 to 30 mL of 0.5% bupivacaine under ultrasound guidance. The study groups differ by additional treatments: one group receives an interscalene brachial plexus block with 10 mL of 0.125% bupivacaine around the nerve roots; another group receives an intercostobrachial nerve block with 10 mL of 0.5% bupivacaine near the second and third intercostal space; the third group uses patient-controlled analgesia with fentanyl. Midazolam may be given on request, and fentanyl is administered if pain occurs during surgery. Participants will be monitored for tourniquet pain incidence within two hours after surgery, along with hemodynamic changes, adverse reactions, and patient satisfaction up to 24 hours. Pain quality and location will be documented if pain arises during surgery. The study involves patients aged 18 to 70 undergoing forearm orthopedic or plastic surgery with specific anesthesia eligibility. Safety and effectiveness data collected during and after surgery will help determine the best pain management technique for this setting.

Analgesic Effect of Supraclavicular Block and Interscalene Analgesia Versus an Intercostobrachial Nerve Block Versus PCA in Forearm Surgery