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

IF 1.4 4区 医学 Q2 EMERGENCY MEDICINE
Henry Tsao, Christopher Tang, Adam Cureton, Laura Maskell, Mark Trembath, Philip Jones, Peter J. Snelling
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引用次数: 0

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.

锁骨上阻滞对上肢损伤急诊复位的影响(SUPERB):一项开放标签、非效性随机对照试验
目的评价急诊医师采用超声引导下锁骨上阻滞(UGSCB)对上肢骨折或脱位闭合复位的疗效,并与Bier阻滞(BB)进行比较。方法:该试验为开放标签、非劣效性随机对照试验。年龄≥18岁的成年人在城区ED中出现桡骨远端和/或尺骨骨折,需要紧急复位。患者被随机分配到使用0.75%罗哌卡因的UGSCB组或使用0.5%利多卡因或0.5%丙胺卡因的BB组,由急诊医生执行。主要结局是患者报告的闭合复位期间的最大疼痛,通过10厘米视觉模拟评分(VAS)测量,非劣效性边缘为2厘米。次要结局包括术后1小时疼痛和不良事件。结果78例患者入组,每组39例。意向治疗分析显示,与BB术后相比,UGSCB术后闭合复位期间的最大疼痛并不差(UGSCB:中位数0.1 cm,四分位数范围[IQR] 0 ~ 2.1;BB: 0.6 cm, IQR 0 ~ 3.3;中位数差- 0.5 cm, 95%置信区间[95% CI] - 1.7 ~ 0.7 cm;非劣效性<; 0.001)。干预后1小时UGSCB的疼痛明显降低(中位数差异为- 1.8 cm, 95% CI为- 2.6至- 1.0)。组间不良事件发生率无差异(优势比2.1;95% CI 0.18 ~ 24)。结论急诊医师实施的UGSCB提供了安全有效的区域麻醉,对于闭合复位期间的最大疼痛不低于BB,具有延长镇痛时间的潜在优势。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Emergency Medicine Australasia
Emergency Medicine Australasia 医学-急救医学
CiteScore
3.70
自引率
13.00%
发文量
217
审稿时长
6-12 weeks
期刊介绍: Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine. Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.
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