Hassanin Jalil1, Florence Polfliet1, Kristof Nijs1, Liesbeth Bruckers2, Gerrit De Wachter3, Ina Callebaut1,4, Lene Salimans1, Marc Van de Velde5,6, Björn Stessel1,4. 1. Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium. 2. I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium. 3. Department of Orthopedic Surgery, Jessa Hospital, Hasselt, Belgium. 4. Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium. 5. Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium. 6. Department of Anaesthesiology, University Hospital, Leuven, Belgium.
Abstract
BACKGROUND AND OBJECTIVES: Distal upper extremity surgery is commonly performed under regional anaesthesia, including intravenous regional anaesthesia (IVRA) and ultrasound-guided forearm nerve block. This study aimed to investigate if ultrasound-guided forearm nerve block is superior to forearm IVRA in producing a surgical block in patients undergoing carpal tunnel release. METHODS: In this observer-blinded, randomized controlled superiority trial, 100 patients undergoing carpal tunnel release were randomized to receive ultrasound-guided forearm nerve block (n = 50) or forearm IVRA (n = 50). The primary outcome was anaesthetic efficacy evaluated by classifying the blocks as complete vs incomplete. Complete anaesthesia was defined as total sensory block, incomplete anaesthesia as mild pain requiring more analgesics or need of general anaesthesia. Pain intensity on a numeric rating scale (0-10) was recorded. Surgeon satisfaction with hemostasis, surgical time, andOR stay time were recorded. Patient satisfaction with the quality of the block was assessed at POD 1. RESULTS: In total, 43 (86%) of the forearm nerve blocks were evaluated as complete, compared to 33 (66%) of the forearm IVRA (p = 0.019). After the forearm nerve block, pain intensity was lower at discharge (-1.76 points lower, 95% CI (-2.92, -0.59), p = 0.0006) compared to patients treated with forearm IVRA. No differences in pain experienced at the start of the surgery, during surgery, and at POD1, nor in surgical time or total OR stay were observed between groups. Surgeon (p = 0.0016) and patient satisfaction (p = 0.0023) were slightly higher after forearm nerve block. CONCLUSION: An ultrasound-guided forearm nerve block is superior compared to forearm IVRA in providing a surgical block in patients undergoing carpal tunnel release. TRIAL REGISTRATION: This trial was registered as NCT03411551.
RCT Entities:
BACKGROUND AND OBJECTIVES: Distal upper extremity surgery is commonly performed under regional anaesthesia, including intravenous regional anaesthesia (IVRA) and ultrasound-guided forearm nerve block. This study aimed to investigate if ultrasound-guided forearm nerve block is superior to forearm IVRA in producing a surgical block in patients undergoing carpal tunnel release. METHODS: In this observer-blinded, randomized controlled superiority trial, 100 patients undergoing carpal tunnel release were randomized to receive ultrasound-guided forearm nerve block (n = 50) or forearm IVRA (n = 50). The primary outcome was anaesthetic efficacy evaluated by classifying the blocks as complete vs incomplete. Complete anaesthesia was defined as total sensory block, incomplete anaesthesia as mild pain requiring more analgesics or need of general anaesthesia. Pain intensity on a numeric rating scale (0-10) was recorded. Surgeon satisfaction with hemostasis, surgical time, and OR stay time were recorded. Patient satisfaction with the quality of the block was assessed at POD 1. RESULTS: In total, 43 (86%) of the forearm nerve blocks were evaluated as complete, compared to 33 (66%) of the forearm IVRA (p = 0.019). After the forearm nerve block, pain intensity was lower at discharge (-1.76 points lower, 95% CI (-2.92, -0.59), p = 0.0006) compared to patients treated with forearm IVRA. No differences in pain experienced at the start of the surgery, during surgery, and at POD1, nor in surgical time or total OR stay were observed between groups. Surgeon (p = 0.0016) and patient satisfaction (p = 0.0023) were slightly higher after forearm nerve block. CONCLUSION: An ultrasound-guided forearm nerve block is superior compared to forearm IVRA in providing a surgical block in patients undergoing carpal tunnel release. TRIAL REGISTRATION: This trial was registered as NCT03411551.
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