International Journal of Scientific Research in Dental and Medical Sciences

International Journal of Scientific Research in Dental and Medical Sciences

Comparison of Incidence of Tourniquet Pain with Ultrasound-guided Infraclavicular and Axillary Approach of Brachial Plexus Block in Adult Patients: A Randomized Controlled Trial

Document Type : Original Article

Authors
Mamta Bhardwaj
Karishma Dhankhar
Kiranpreet Kaur
Ashish Yadav
Karthik Manoharan
Anuj Tripathi
Department of Anaesthesiology & Critical care, Pt. BD Sharma PGIMS, University of Health Sciences, Rohtak, India
10.30485/ijsrdms.2026.552962.1715
Abstract
Background and aim: Tourniquet pain is a common concern during upper-limb surgery under brachial plexus block. This study compared the incidence and severity of tourniquet pain following ultrasound-guided axillary (AX) and infraclavicular (IC) brachial plexus blocks.
Material and methods: In this prospective randomized controlled trial, 44 adults aged 18–60 years, classified as ASA I–III and undergoing upper-limb surgery requiring a tourniquet for more than 45 minutes, were randomized to receive ultrasound-guided AX or IC brachial plexus block. Both groups received 24 mL of local anesthetic. We assessed tourniquet pain using a visual analog scale (VAS). We also evaluated block characteristics, procedural time, adverse events, and patient and surgeon satisfaction.
Results: We analyzed 22 patients in the AX group and 21 in the IC group after one patient in the IC group experienced block failure. Tourniquet pain occurred in 6 patients (27.3%) in the AX group and 2 patients (9.5%) in the IC group, with no statistically significant difference (p=0.240; RR=0.35, 95% CI: 0.08–1.54). Four AX patients had mild pain, and two had moderate pain, while both IC patients had mild pain. Needling time (p=0.006) and total block performance time (p=0.016) were significantly longer with IC block. Other block characteristics, adverse events, and satisfaction scores were comparable.
Conclusions: We found no statistically significant difference in the incidence or severity of tourniquet pain between ultrasound-guided AX and IC brachial plexus blocks. IC block required a longer procedural time.
Keywords
Brachial Plexus Block
Pain
Tourniquets
Ultrasonography
Upper Extremity
Subjects
[1] Brenner D, Iohom G, Mahon P, Shorten G. Efficacy of axillary versus infraclavicular brachial plexus block in preventing tourniquet pain: a randomised trial. European Journal of Anaesthesiology EJA. 2019;36(1):48-54. https:doi.org/10.1097/EJA.0000000000000928.
[2] Sauter AR, Smith HJ, Stubhaug A, Dodgson MS, Klaastad Ø. Use of magnetic resonance imaging to define the anatomical location closest to all three cords of the infraclavicular brachial plexus. Anesthesia & Analgesia. 2006;103(6):1574-6. https://doi.org/10.1213/01.ane.0000242529.96675.fd.
[3] Tschaikowsky K, Hemmerling T. Comparison of the effect of EMLA and semicircular subcutaneous anaesthesia in the prevention of tourniquet pain during plexus block anaesthesia of the arm. Anaesthesia. 1998;53(4):390-3. https://doi.org/10.1046/j.1365-2044.1998.00301.x.
[4] Kam PC, Kavanaugh R, Yoong FF. The arterial tourniquet: pathophysiological consequences and anaesthetic implications. Anaesthesia. 2001;56(6):534-45. https://doi.org/10.1046/j.1365-2044.2001.01982.x
[5] Deloughry JL, Griffiths R. Arterial tourniquets. Continuing Education in Anaesthesia, Critical Care & Pain. 2009;9(2):56-60. https://doi.org/10.1093/bjaceaccp/mkp002.
[6] Ayyavu C, Rajamani G, Devi K, Anandan H. A comparative study of brachial plexus block using infraclavicular (coracoid) and axillary approaches in forearm surgery. International Journal of Contemporary Medical Research. 2016;3(9):2507-10.
[7] Song IA, Gil NS, Choi EY, Sim SE, Min SW, Ro YJ, et al. Axillary approach versus the infraclavicular approach in ultrasound-guided brachial plexus block: comparison of anesthetic time. Korean journal of anesthesiology. 2011;61(1):12-8. https://doi.org/10.4097/kjae.2011.61.1.12.
[8] Frederiksen BS, Koscielniak‐Nielsen ZJ, Jacobsen RB, Rasmussen H, Hesselbjerg L. Procedural pain of an ultrasound‐guided brachial plexus block: a comparison of axillary and infraclavicular approaches. Acta Anaesthesiologica Scandinavica. 2010;54(4):408-13. https://doi.org/10.1111/j.1399-6576.2009.02197.x.
[9] Abhinaya RJ, Venkatraman R, Matheswaran P, Sivarajan G. A randomised comparative evaluation of supraclavicular and infraclavicular approaches to brachial plexus block for upper limb surgeries using both ultrasound and nerve stimulator. Indian journal of anaesthesia. 2017;61(7):581-6. https://doi.org/10.4103/ija.IJA_402_16.
[10] Sebastian MP, Etxebarria A, Perez P, Lauzirika Z, Anton-adislao A, Martinez-Bourio R. Tourniquet pain after ultrasound-guided axillary blockade. J Anest & Inten Care Med. 2017;3:555624. DOI: 10.19080/JAICM.2017.03.555624
[11]Estebe JP, Le Naoures A, Chemaly L, Ecoffey C. Tourniquet pain in a volunteer study: effect of changes in cuff width and pressure. Anaesthesia. 2000;55(1):21-6. https://doi.org/10.1046/j.1365-2044.2000.01128.x.
International Journal of Scientific Research in Dental and Medical Sciences
Volume 8, Issue 1
Winter 2026
Pages 33-39

  • Receive Date 14 January 2026
  • Revise Date 19 February 2026
  • Accept Date 28 February 2026
  • Publish Date 01 March 2026