Supraclavicular Block vs Bier's Block for Forearm Trauma Surgery

Sargodha Medical College66 enrolled

Overview

This study compared two common anesthesia techniques used for forearm trauma surgery-Bier's block and the supraclavicular block-to determine which provides better surgical conditions and patient comfort. Among the 66 patients studied, Bier's block produced a much faster onset of numbness and muscle relaxation, but its pain relief wore off quickly. In contrast, the supraclavicular block took longer to take effect but provided significantly longer-lasting postoperative pain relief and greater overall patient comfort, making it more suitable for trauma cases where prolonged anesthesia and smoother recovery are needed. Overall, the study found the supraclavicular block to be the more effective and patient-friendly option for forearm surgeries.

Forearm trauma surgery commonly requires regional anesthesia to provide surgical conditions and postoperative pain relief. Two widely used techniques are Bier's block (intravenous regional anesthesia) and the supraclavicular brachial plexus block, but limited evidence exists comparing their performance specifically in trauma patients. This randomized controlled trial evaluates these two approaches to determine differences in onset of sensory and motor block, duration of postoperative analgesia, and patient comfort. Bier's block is known for its simplicity and rapid onset but is limited by tourniquet pain and a short duration of analgesia once the tourniquet is released. In contrast, the supraclavicular block provides dense anesthesia of the upper limb with the potential for longer postoperative pain relief, especially when performed under ultrasound guidance. In this study, 66 adult patients undergoing forearm surgery were randomized to receive either Bier's block or supraclavicular block using standardized techniques. An independent observer assessed block onset and recovery characteristics, and patient comfort was recorded using validated scales. The goal of this study is to generate evidence that may guide anesthetic selection for forearm trauma cases by identifying which block technique offers better perioperative performance and enhances postoperative pain control while avoiding unnecessary duplication of data reported in other fields of the trial record.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

Interventions

Bier's Block (IVRA)PROCEDURE

Participants received an intravenous regional anesthesia (Bier's block). After placement of an IV line in the distal operative limb, the limb was exsanguinated with an Esmarch bandage and a double-cuff tourniquet was applied. The proximal cuff was inflated 50-100 mmHg above systolic pressure, followed by injection of 30 mL of 0.5% lidocaine through the IV. The distal cuff was inflated after 20-30 minutes or if tourniquet discomfort occurred. This technique produced regional anesthesia for forearm surgery.

Supraclavicular BlockPROCEDURE

Participants received an ultrasound-guided supraclavicular brachial plexus block. Premedication included midazolam (1 mg IV) and nalbuphine (0.1 mg/kg IV). A total of 30 mL local anesthetic was injected using a two-point needle technique under real-time ultrasound visualization. After block establishment, a single tourniquet was applied at 100 mmHg above systolic pressure for the surgical procedure.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adults aged 18 to 60 years * ASA physical status I-III * Patients scheduled for elective or emergency forearm surgery * Presence of forearm fracture or upper limb trauma requiring regional anesthesia * Ability to provide informed consent Exclusion Criteria: * Patient refusal or inability to give informed consent * Known allergy to local anesthetic agents * Coagulopathy or bleeding disorders * Infection at the block site * Pre-existing neurological deficits in the affected limb * Severe cardiac, hepatic, or renal disease * History of seizure disorders * Pregnancy * ASA physical status IV or higher * Inability to cooperate with block assessment

Outcomes

Primary Outcomes

1)onset of sensory block 2)degree of motor blockade

ONSET OF SENSORY BLOCK It is the period of time between the local anesthesia injection and the loss of pinprick sensation. 0=feeling sharp pinprick (no block) 1. blunt sensation on pinprick (partial block) 2. no sensation on pinprick (complete block). DEGREE OF MOTOR BLOCKADE Motor blockade was assessed by modified Bromage scale 0 = normal muscle function with full range of movement of elbow, wrist and fingers 1 = decreased muscle power so that patient can move fingers and /or wrist only 2 = complete loss of muscle function with movement in fingers/wrist

Time frame: 6 months

Secondary Outcomes

3)duration of analgesia

DURATION OF ANALGESIA It was calculated from the time of onset of loss of pinprick for the first time during post-operative period (next 24 hrs.). The Visual Analogue Scale was used to determine pain scores.