Clinical Research Directory

Perfusion Index in Monitoring Recovery From Brachial Plexus Block After Forearm Surgery

Postoperative differentiation between residual regional anesthetic effect and other causes of persistent sensory or motor deficit is a common clinical problem after peripheral nerve blocks. Perfusion index (PI), a noninvasive pulse oximetry-derived measure of peripheral perfusion, rises after sympathetic blockade and has been studied for predicting block success and duration. However, its ability to detect the resolution of a block has not been established. This prospective observational study will evaluate the diagnostic accuracy of the PI ratio between the blocked and contralateral hand for detecting sensory and motor block resolution in adult patients undergoing elective forearm surgery under ultrasound-guided infraclavicular brachial plexus block. PI, sensory block (pinprick), and motor block will be assessed repeatedly from before the block until 24 hours postoperatively. Cut-off values of the PI ratio for the first regression and the complete resolution of sensory and motor block will be determined using ROC analysis.

Dose-Finding Study: MEV90 for Local Anesthetic in Interscalene Block for Supraclavicular Nerves Block

This study aims to determine the minimum effective volume (MEV90) of local anesthetic required to achieve sensory block of the supraclavicular nerves when performing a single-shot ultrasound-guided interscalene brachial plexus block (ISB). These nerves provide sensation to the skin over the clavicle and shoulder and are often involved in surgeries such as shoulder arthroscopy and clavicle repair.

Nociception Level Index After Brachial Plexus Block In Upper Extremity Surgery

The present prospective within-subject observational study will evaluate whether unilateral brachial plexus block (BPB) induces measurable lateralized autonomic modulation, assesses using bilateral Nociception Level (NoL) monitoring during standardized intraoperative stimuli under general anesthesia. Regional anesthesia efficacy is traditionally assessed through sensory and motor examination. However, objective physiologic markers reflecting sympathetic modulation remain limited. Forty five adults undergoing upper extremity surgery with BPB and general anesthesia, bilateral NoL monitoring will be performed during local anesthetic injection, endotracheal intubation, and nasogastric tube placement. The primary aim to investigate whether the brachial plexus block induces unilateral modulation of post-operative nervous system activity, assessed by inter-limb differences in NoL values during predefined nociceptive stimuli under general anesthesia. The secondary aim to evaluate the correlation between postoperative metrics, postoperative pain intensity, and analgesic consumption. From a clinical perspective, bilateral autonomic monitoring may offer a novel adjunctive method for intraoperative confirmation of block activity, particularly in sedated or anesthetized patients where traditional sensory testing is not feasible. Furthermore, inter-limb autonomic gradients could represent a future research pathway for objective assessment of regional anesthesia effectiveness beyond subjective pain scores.

Efficacy of Different Medications as Adjuvants in Ultrasound-guided Supraclavicular Brachial Plexus Block in Forearm Surgeries

This study is to evaluate whether addition of dexmedetomidine, dexamethasone and magnesium sulfate as adjuvants to bupivacaine in supraclavicular Brachial Plexus Blockade (BPB) for pain management assessed by VAS score.