Tourniquet Pain Prevention During Distal Upper Limb Surgery

Post-tourniquet pain remains a common problem. It disturbs the quality of anesthesia during brachial plexus block for distal upper-limb surgery. Current evidence shows that adding an intercostobrachial nerve block using the landmark-based technique can improve analgesia for medial upper-arm procedures.

Inclusion Criteria: * Elective unilateral distal upper-limb surgery (hand, wrist or forearm) with use of pneumatic upper-arm tourniquets under ultrasound-guided brachial plexus block. Exclusion Criteria: * Coagulopathy or therapeutic anticoagulation. * Local infection at injection sites. * Chronic opioid dependence.