Ultrasound-guided supraclavicular block versus Bier block for emergency reduction of upper limb injuries: a protocol for an open-label, non-inferiority, randomised controlled trial

Trials

Study Protocol

Philip Jones¹  Christopher Tang²  Henry Tsao²  Mark Trembath³  Peter J. Snelling⁴ 

[1] Department of Emergency Medicine, Gold Coast University Hospital, Southport, QLD, Australia;Emergency Department, Redland Hospital, Cleveland, QLD, Australia;School of Medicine, The University of Queensland, Herston, QLD, Australia;School of Medicine, The University of Queensland, Herston, QLD, Australia;Department of Anaesthetics, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia;School of Medicine, The University of Queensland, Herston, QLD, Australia;Department of Emergency Medicine, Gold Coast University Hospital, Southport, QLD, Australia;School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia;Sonography Innovation and Research Group (Sonar Group), Southport, QLD, Australia;

关键词: Supraclavicular block;    Nerve block;    Bier block;    Regional anaesthesia;    Emergency medicine;    Randomised controlled trial;    Ultrasonography;    Upper limb injury;    Pain;   

DOI  :  10.1186/s13063-023-07403-z

 received in 2023-03-24, accepted in 2023-05-22,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundClosed reduction of upper limb fractures and/or dislocations are common in the emergency department (ED), which involves physically re-aligning the injured part prior to immobilisation. As this is painful, numerous techniques are available to provide regional anaesthesia to ensure patient tolerance. A Bier block (BB) is typically performed as part of routine care. An alternative technique gaining interest in the ED is ultrasound-guided supraclavicular block (UGSCB), which involves injecting local anaesthetic around the brachial plexus at the supraclavicular fossa under ultrasound guidance. It is unclear whether UGSCB is effective and safe when performed in the ED.MethodsSUPERB (SUPraclavicular block for Emergency Reduction versus Bier block) is a prospective open-label, non-inferiority randomised controlled trial that compares the effectiveness of UGSCB versus BB for closed reduction of upper limb fractures and/or dislocations. Adult patients presenting with an upper limb fracture and/or dislocation that requires emergent closed reduction in the ED will be eligible. After screening, participants will be randomised to either UGSCB or BB. Once regional anaesthesia is obtained, closed reduction of the injured part will be performed and appropriately immobilised. The primary outcome is maximal pain experienced during closed reduction measured via a visual analogue scale (VAS). Secondary outcomes include baseline and post-reduction pain, patient satisfaction, total opioid requirement in ED, ED length of stay, adverse events and regional anaesthesia failure.DiscussionExisting evidence suggests UGSCB is effective when performed in the operating theatre by trained anaesthetists. SUPERB will be the first randomised controlled trial to elucidate the effectiveness and safety of UGSCB in the ED. The findings have the potential to provide an alternative safe and effective option for the management of upper extremity emergencies in the ED.Trial registrationThis trial has been registered on 21 October 2022 with Australia and New Zealand Clinical Trials Registry (ACTRN12622001356752).

【 授权许可】

CC BY   
© Crown 2023