The analgesic efficacy of forearm versus upper arm intravenous regional anesthesia (Bier's block): A randomized controlled non-inferiority trial

Kristof Nijs, André Lismont, Gerrit De Wachter, Victoria Broux, Ina Callebaut, Jean-Paul Ory, Hassanin Jalil, Jan Poelaert, Marc Van de Velde, Björn Stessel

Onderzoeksoutput: Article

Samenvatting

STUDY OBJECTIVE: This study aimed to assess if a forearm (FA) intravenous regional anesthesia (IVRA) with a lower, less toxic, local anesthetic dosage is non-inferior to an upper arm (UA) IVRA in providing a surgical block in patients undergoing hand and wrist surgery.

DESIGN: Observer-blinded, randomized non-inferiority study.

SETTING: Operating room.

PATIENTS: 280 patients undergoing hand surgery were randomly assigned to UA IVRA (n = 140) or FA IVRA (n = 140).

INTERVENTIONS: Forearm IVRA or upper arm IVRA in patients undergoing hand and wrist surgery.

MEASUREMENTS: The primary outcome was block success rate of both techniques. Block success was defined as no need of additional analgesics. A second, alternative non-inferiority outcome was defined as no need of conversion to general anesthesia. A difference in success rate of <5% was considered non-inferior. Secondary endpoints were tourniquet pain measured with a Numerical Rating Scale (0-10), satisfaction of patients and surgeons, onset time, surgical time and total OR time.

MAIN RESULTS: Non-inferiority of block success rate, defined as no need of additional analgesics or conversion to general anesthesia was inconclusive (5.24%, 95% CI:-4.34%,+14.82%). Non-inferiority of no need of conversion to general anesthesia was confirmed (+0.73%, 95% CI:-0.69%,+2.15%). No differences were observed in onset time (FA: 5 (5, 8) vs UA: 6 (5, 7) min, p = 0.74), surgical time (FA: 8 (5, 12) vs UA: 7 (5, 11) min, p = 0.71), nor total OR stay time (FA: 34 (27, 41) vs UA: 35 (32, 39) min, p = 0.09). Tourniquet pain after 10 min was significantly lower after FA IVRA compared to UA IVRA (FA: 2.00 (0.00, 4.00) vs UA: 3.00 (1.00,5.00) min, p = 0.003).

CONCLUSION: We failed to demonstrate non-inferiority of forearm IVRA with a lower dosage of LA in providing a surgical block without rescue opioids and LA. Non-inferiority of no need of conversion to general anesthesia was confirmed.

Originele taal-2English
Artikelnummer110329
TijdschriftJournal of Clinical Anesthesia
Volume73
Vroegere onlinedatum5 mei 2021
DOI's
StatusE-pub ahead of print - 5 mei 2021

Bibliografische nota

Copyright © 2021 Elsevier Inc. All rights reserved.

Vingerafdruk

Duik in de onderzoeksthema's van 'The analgesic efficacy of forearm versus upper arm intravenous regional anesthesia (Bier's block): A randomized controlled non-inferiority trial'. Samen vormen ze een unieke vingerafdruk.

Citeer dit