Supraclavicular Block vs Bier's Block for Forearm Trauma Surgery

NCT07418086 | Completed

• 1 other identifier: SMC-ANS-2025-004
• Study Type: interventional
• Target: 66
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Forearm Fractures

Keywords

Brachial Plexus Block

Outcome Measures

Primary Outcomes (1)

• 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

  6 months

Secondary Outcomes (1)

• 3)duration of analgesia

  6 months

Other Outcomes (1)

• 4)patient comfort

  6 months

Study Arms (2)

Bier's Block (IVRA)

EXPERIMENTAL

Participants assigned to this arm received a Bier's block (Intravenous Regional Anesthesia). After IV access was established distally in the operative limb, the limb was exsanguinated using an Esmarch bandage and a double pneumatic tourniquet was applied. The proximal cuff was inflated 50-100 mmHg above systolic pressure, followed by IV administration of 30 mL of 0.5% lidocaine. The distal cuff was inflated after 20-30 minutes or upon tourniquet discomfort. This technique provided regional anesthesia for forearm surgery.

Procedure: Bier's Block (IVRA)

Supraclavicular Block

EXPERIMENTAL

Participants received an ultrasound-guided supraclavicular brachial plexus block. After premedication with midazolam (1 mg) and nalbuphine (0.1 mg/kg), a 30 mL local anesthetic dose was injected using a two-point needle technique under real-time ultrasound visualization. A single tourniquet was applied at 100 mmHg above systolic pressure after block establishment. This technique provided anesthesia for forearm trauma surgery.

Procedure: Supraclavicular Block

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.

Bier's Block (IVRA)

Supraclavicular Block PROCEDURE

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.

Supraclavicular Block

Eligibility Criteria

• Age: 18 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• 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

You may not qualify if:

• 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

Sponsors & Collaborators

• Sargodha Medical College: lead

Study Sites (1)

DHQ Sargodha

Sargodha, Punjab Province, 40100, Pakistan

Location

Related Publications (5)

• Dodds SD, et al. The utility of CT scans for distal radius fractures. J Hand Surg. 2008;33:954-957.

  BACKGROUND

• Small J, Brennwald J. Median nerve palsy associated with distal radius fracture. J Hand Surg. 1994;19:185-186.

  BACKGROUND

• Pidgeon TS, et al. The operative treatment of distal radial fractures: a review of evidence. J Hand Surg. 2010;35:654-660.

  BACKGROUND

• Houshian S, Torfing T, Borris LC. The epidemiology of elbow fractures in adults. J Shoulder Elbow Surg. 2001;10:43-47.

  BACKGROUND

• Lamblet Z, Derossis AM, Isler MH, Sanders DW. Isolated ulnar shaft fractures can be treated with closed reduction and cast immobilization: a retrospective review. J Bone Joint Surg Am. 2004;86-A:1901-1905.

  RESULT

Related Links

• Related Info

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: An independent outcomes assessor was blinded to group allocation. This assessor was not involved in administering the anesthesia and had no knowledge of whether the participant received a Bier's block or a Supraclavicular block. Sensory block onset, motor block onset, and patient comfort scores were evaluated by this blinded assessor to minimize assessment bias. No other study personnel were masked due to the distinct nature of the two anesthesia techniques.
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: postgraduation resident

Model Details: This study used a parallel interventional design, in which participants were randomly allocated into two independent groups. Each group received a different intervention, and all participants remained in their assigned group for the entire duration of the study. Outcomes-including onset of sensory block, motor block, duration of analgesia, and patient comfort-were measured and compared between the two groups without crossover. Group B received Bier's block (IVRA) and Group S received Supraclavicular block, allowing a direct comparison of the effectiveness of both anesthesia techniques in forearm trauma surgery.

Study Record Dates

• First Submitted: December 1, 2025
• First Posted: February 18, 2026
• Study Start: April 1, 2023
• Primary Completion: January 1, 2024
• Study Completion: February 1, 2024
• Last Updated: February 18, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)