Classic Versus Interfascial Axillary Block in Hand, Wrist, and Forearm Surgery

Condition(s) studied

Investigational drug(s) / intervention(s)

Classic Axillary Block: Classic (perivascular/perineural) axillary brachial plexus block

Interfascial Axillary Block: Interfascial (fascial-plane) axillary brachial plexus block.

Study summary

Hand, wrist, and forearm surgeries are commonly performed procedures with significant postoperative pain potential. Regional anesthesia of the brachial plexus via the axillary approach is one of the gold-standard techniques for distal upper-limb surgery. In the conventional (classic) axillary block, the median, ulnar, and radial nerves within the axillary sheath are individually targeted under ultrasound guidance; however, anatomical septations around the axillary artery may prevent homogeneous spread of local anesthetic, leading to a patchy block and reduced intraoperative success.

The interfascial axillary block is a modified approach in which local anesthetic is deposited into the fascial planes between the axillary muscles rather than directly into the nerve sheath, aiming for passive diffusion, homogeneous spread, and fewer needle manipulations. This prospective, randomized, single-center study compares the classic axillary block with the interfascial axillary block in patients undergoing hand, wrist, and forearm surgery, primarily in terms of surgical anesthesia adequacy (block success).

Eligibility

Primary outcome measure(s)

• Surgical anesthesia adequacy (block success) — 30 minutes after block
  Complete sensory and motor blockade of the surgical field, allowing the operation to be completed without additional local infiltration or conversion to general anesthesia

Trial sites (1)

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