Comparison of the effect of axillary block alone versus axillary block + subcutaneous injection of local anesthetic on tourniquet pain relief in upper limb orthopedic surgeries

Determining the effect of axillary block + subcutaneous lidocaine infiltration on reducing tourniquet pain in orthopedic surgeries of the forearm, wrist or hand with using tourniquet

A randomized, double-blinded, controlled clinical trial with a parallel group enrolled 78 patients. Random number table is used for randomization.

This study is performed in Akhtar Hospital . The severity of the tourniquet pain is measured immediately after inflating the tourniquet and then every 15 minutes with the Verbal Rating Scale. The first complaint of tourniquet pain is recorded during surgery. If the patient complains of tourniquet pain or VRS>1, intravenous fentanyl and, if necessary, ketamine is injected. If the pain persists, propofol is infused and if there is no response, general anesthesia is performed. Doses of fentanyl, ketamine, and propofol are also recorded.Participants, researchers and outcome assessors are unaware of the allocation of study groups.

78 patients aged 15 years and older ASA class Ⅰ- Ⅲ scheduled for orthopedic surgery of the forearm, wrist or hand under the sono-guided axillary block with the use of tourniquets are included. Cases of rejection, lidocaine hypersensitivity, coagulation disorders, opium addiction, non-cooperation, block site infection, BMI≥30, DVT, sickle cell anemia, tourniquet inflation time of less than 30 minutes are excluded.

Patients are randomly divided into two equal groups of axillary block alone and axillary block + subcutaneous infiltration of lidocaine. In the axillary block alone group, 5 ml of normal saline and in the Intervention group, 5 ml of 1.5% lidocaine are injected subcutaneously in the upper inner part of the upper arm.

The severity of tourniquet pain and the total amount of administered fentanyl, ketamine and propofol.

Participants are randomly assigned to 1 of 2 groups following simple randomization by using a random numbers table. The allocation sequence is concealed in sealed envelopes. In the operating room, the envelope is opened by an investigator with no clinical involvement in the trial.

Randomization and assignment of patients in each group is done by a person not involved in the study. The investigators and persons who measures the outcome in two groups are also kept blinded.