Supraclavicular Block vs Bier's Block for Forearm Trauma Surgery

February 17, 2026 updated by: Abira Rashid, Sargodha Medical College

Comparative Study of Supraclavicular Block and Bier's Block in Forearm Surgery in Trauma Patients

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.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

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

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
66

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • Punjab Province
      • Sargodha, Punjab Province, Pakistan, 40100
        • DHQ Sargodha

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Bier's Block (IVRA)
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)
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.
Experimental: Supraclavicular Block
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
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.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
1)onset of sensory block 2)degree of motor blockade
Time Frame: 6 months

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 Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
3)duration of analgesia
Time Frame: 6 months
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.
6 months

Other Outcome Measures

Other Outcome Measures

For clinical trials, a planned measurement described in the protocol that is used to determine the effect of an intervention/treatment on participants. For observational studies, a measurement or observation that is used to describe patterns of diseases or traits, or associations with exposures, risk factors, or treatment. Types of outcome measures include primary outcome measure and secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
4)patient comfort
Time Frame: 6 months
The modified Gloucester scale will be used to assess it.
6 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Sargodha Medical College

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

  • Dodds SD, et al. The utility of CT scans for distal radius fractures. J Hand Surg. 2008;33:954-957.
  • Small J, Brennwald J. Median nerve palsy associated with distal radius fracture. J Hand Surg. 1994;19:185-186.
  • Pidgeon TS, et al. The operative treatment of distal radial fractures: a review of evidence. J Hand Surg. 2010;35:654-660.
  • Houshian S, Torfing T, Borris LC. The epidemiology of elbow fractures in adults. J Shoulder Elbow Surg. 2001;10:43-47.
  • 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.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
April 1, 2023

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
January 1, 2024

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
February 1, 2024

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
December 1, 2025

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
February 17, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
February 18, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
February 18, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
February 17, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
February 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • SMC-ANS-2025-004

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Your study is a single-center anesthesia comparison trial.

There is no requirement to share individual participant data (IPD).

Unless you have a formal data-sharing mechanism (repository, request process, timelines), selecting Yes will create extra mandatory fields.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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