Early Detection of Supraclavicular Brachial Plexus Block Failure Using Infrared Thermography and Perfusion Index

NCT ID: NCT07092891

Last Updated: 2025-07-30

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 80 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-08-15
• Study Completion Date: 2026-09-01

Brief Summary

Successful peripheral nerve blockade is fundamental to modern regional anesthesia, particularly for upper limb surgeries. Ensuring the efficacy of a nerve block early in the perioperative period is critical, as delayed recognition of block failure may lead to intraoperative pain, the need for additional sedation or general anesthesia, and overall poorer patient outcomes. Conventional methods for assessing block success, such as sensory testing with pinprick or cold stimuli and motor assessment using strength scales, require patient cooperation and often take 15-30 minutes to yield definitive results. These delays are especially limiting in fast-paced surgical environments or when early decisions regarding anesthesia management are necessary.

Emerging non-invasive monitoring technologies offer promising alternatives for the early, objective assessment of block efficacy. Infrared Thermography (IRT) measures skin surface temperature, which increases due to sympathetic nerve blockade-induced vasodilation.

Detailed Description

Successful peripheral nerve blockade is fundamental to modern regional anesthesia, particularly for upper limb surgeries. Ensuring the efficacy of a nerve block early in the perioperative period is critical, as delayed recognition of block failure may lead to intraoperative pain, the need for additional sedation or general anesthesia, and overall poorer patient outcomes. Conventional methods for assessing block success, such as sensory testing with pinprick or cold stimuli and motor assessment using strength scales, require patient cooperation and often take 15-30 minutes to yield definitive results. These delays are especially limiting in fast-paced surgical environments or when early decisions regarding anesthesia management are necessary.

Emerging non-invasive monitoring technologies offer promising alternatives for early, objective assessment of block efficacy. Infrared Thermography (IRT) measures skin surface temperature, which increases with sympathetic nerve blockade-induced vasodilation. Perfusion Index (PI), derived from pulse oximetry, reflects peripheral perfusion and also rises as vascular tone decreases following a successful nerve block. Both IRT and PI provide quantifiable, real-time physiological markers of sympathetic and circulatory changes that precede full sensory or motor blockade. Although several studies support their individual utility, there is limited evidence on their combined predictive value or their integration into routine clinical practice. Further investigation is needed to validate their role in enhancing the accuracy and timeliness of block assessment.

Conditions

Regional Anaesthsia; Brachial Plexus Blocks

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: DIAGNOSTIC
• Blinding Strategy: NONE

Study Groups

Supraclavicular Brachial Plexus Block with Thermographic and Perfusion Monitoring

Participants will receive an ultrasound-guided supraclavicular brachial plexus block using 30 mL of 0.5% bupivacaine for upper limb surgery. Infrared thermography and perfusion index measurements will be recorded at baseline, and at 5, 10, and 15 minutes post-block to detect early physiological changes. Clinical assessment of sensory and motor block will be performed at 20 minutes post-injection using standardized testing. The goal is to evaluate the predictive accuracy of these non-invasive measures in detecting block success or failure.

Group Type: EXPERIMENTAL

Ultrasound-Guided Supraclavicular Block

Intervention Type: PROCEDURE

Ultrasound-guided supraclavicular brachial plexus block using a high-frequency linear ultrasound probe-real-time visualization of the brachial plexus for precise anesthetic delivery.

Bupivacaine Hydrochloride 0.5 % Injectable Solution

Intervention Type: DRUG

30 mL used for supraclavicular brachial plexus block

Ultrasound

Intervention Type: DEVICE

Imaging for block placement

Infrared Thermography Camera

Intervention Type: DEVICE

Skin temperature monitoring

Pulse Oximeter

Intervention Type: DEVICE

Perfusion Index monitoring

Interventions

Ultrasound-Guided Supraclavicular Block

Ultrasound-guided supraclavicular brachial plexus block using a high-frequency linear ultrasound probe-real-time visualization of the brachial plexus for precise anesthetic delivery.

Intervention Type: PROCEDURE

Bupivacaine Hydrochloride 0.5 % Injectable Solution

30 mL used for supraclavicular brachial plexus block

Intervention Type: DRUG

Ultrasound

Imaging for block placement

Intervention Type: DEVICE

Infrared Thermography Camera

Skin temperature monitoring

Intervention Type: DEVICE

Pulse Oximeter

Perfusion Index monitoring

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• Adults aged 18-70 years
• ASA Physical Status I-III

Exclusion Criteria

• General

• Coagulopathy
• Allergy to local anesthetics
• Special

• Neurological deficits in the affected limb
• Peripheral vascular disease or Raynaud's phenomenon
• Infections or skin lesions at the site of injection
• Use of a tourniquet

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 70 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Assiut University

OTHER

Sponsor Role: lead

Responsible Party

Tarek Ashraf Ibrahim Abd Al-Hafiz

resident doctor at Assiut University hospital

Responsibility Role: PRINCIPAL_INVESTIGATOR

Central Contacts

Tarek Ashraf Ibrahim Abd Al-Hafiz, resident doctor

Role: CONTACT

tarek.15235463@med.aun.edu.eg

+201092002284

References

Gamal M, Hasanin A, Adly N, Mostafa M, Yonis AM, Rady A, Abdallah NM, Ibrahim M, Elsayad M. Thermal Imaging to Predict Failed Supraclavicular Brachial Plexus Block: A Prospective Observational Study. Local Reg Anesth. 2023 Jun 9;16:71-80. doi: 10.2147/LRA.S406057. eCollection 2023.

Reference Type: BACKGROUND

PMID: 37323293 (View on PubMed)

Abdelnasser A, Abdelhamid B, Elsonbaty A, Hasanin A, Rady A. Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index. Br J Anaesth. 2017 Aug 1;119(2):276-280. doi: 10.1093/bja/aex166.

Reference Type: BACKGROUND

PMID: 28854539 (View on PubMed)

Other Identifiers

Brachial Plexus Block Failure

Identifier Type: -

Identifier Source: org_study_id