SUPraclavicular Block for Emergency Reduction of Upper Limb Injuries Versus Bier Block ( SUPERB ): An Open‐Label, Noninferiority Randomised Controlled Trial

Résumé fourni par la source

ABSTRACT Objectives To assess the effectiveness of ultrasound‐guided supraclavicular block (UGSCB), performed by emergency physicians, for closed reduction of upper limb fractures or dislocations when compared with Bier block (BB). Methods This was an open‐label, noninferiority randomised controlled trial. Adults aged ≥ 18 years presenting to an urban district ED with distal radius and/or ulnar fractures requiring emergent reduction were included. Patients were randomised to either UGSCB using 0.75% ropivacaine or BB using 0.5% lignocaine or 0.5% prilocaine, performed by emergency physicians. The primary outcome was patient‐reported maximal pain during closed reduction measured via a 10 cm visual analogue scale (VAS), with a noninferiority margin of 2 cm. Secondary outcomes included post‐reduction pain at 1‐h and adverse events. Results We enrolled 78 patients with 39 per group. Intention‐to‐treat analysis showed that maximal pain during closed reduction following UGSCB was noninferior compared with that after BB (UGSCB: median 0.1 cm, interquartile range [IQR] 0 to 2.1; BB: 0.6 cm, IQR 0 to 3.3; difference in medians −0.5 cm, 95% Confidence Interval [95% CI] −1.7 to 0.7 cm; pnoninferiority < 0.001). Pain at 1‐h post‐intervention was significantly lower in the UGSCB (difference in median −1.8 cm, 95% CI −2.6 to −1.0). There were no between‐group differences in adverse events (Odds ratio 2.1; 95% CI 0.18 to 24). Conclusions Emergency physician‐performed UGSCB provides safe and effective regional anaesthesia that was non‐inferior to BB for maximal pain during closed reduction, with the potential advantage of prolonged analgesia.

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