Supraclavicular Block vs Bier's Block for Forearm Trauma Surgery

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: Completed
• Conditions: Forearm Fractures
• Intervention / Treatment: Procedure: Bier's Block (IVRA); Procedure: Supraclavicular Block

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: Interventional
• Enrollment (Actual): 66
• Phase: Not Applicable

Contacts and Locations

Study Locations

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

Participation Criteria

Eligibility Criteria

• 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

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
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

Outcome Measure	Measure Description	Time Frame
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); blunt sensation on pinprick (partial block); 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

Outcome Measure	Measure Description	Time Frame
3)duration of analgesia	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

Outcome Measure	Measure Description	Time Frame
4)patient comfort	The modified Gloucester scale will be used to assess it.	6 months

Collaborators and Investigators

• Sponsor: Sargodha Medical College

Publications and helpful links

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

• Related Info

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2023
• Primary Completion (Actual): January 1, 2024
• Study Completion (Actual): February 1, 2024

Study Registration Dates

• First Submitted: December 1, 2025
• First Submitted That Met QC Criteria: February 17, 2026
• First Posted (Actual): February 18, 2026

Study Record Updates

• Last Update Posted (Actual): February 18, 2026
• Last Update Submitted That Met QC Criteria: February 17, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Brachial Plexus Block
• Other Study ID 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