The analgesic efficacy of forearm versus upper arm intravenous regional anesthesia (Bier's block): A randomized controlled non-inferiority trial - 14/06/21
, André Lismont, MD a, e, 1, Gerrit De Wachter, MD f, Victoria Broux, MD a, Ina Callebaut, PhD a, b, Jean-Paul Ory, MD a, Hassanin Jalil, MD a, Jan Poelaert, MD, PhD e, Marc Van de Velde, MD, PhD, EDRA c, d, 2, Björn Stessel, MD, PhD a, b, 2Abstract |
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.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Non-inferiority of the quality of the surgical block after forearm IVRA compared to upper arm IVRA could not be demonstrated. |
• | Non-inferiority of no need of conversion to general anesthesia after forearm IVRA compared to upper arm IVRA was confirmed. |
• | A significant reduction in total operation room time is present in patients undergoing trigger digit release after forearm IVRA compared to upper arm IVRA. |
• | No statistical significant difference in tourniquet tolerance time after forearm IVRA and upper arm IVRA was found. |
Keywords : Bier's block, Intravenous regional anesthesia, IVRA
Plan
Vol 73
Article 110329- octobre 2021 Retour au numéro
Article précédent
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