Summary of findings for the main comparison. infraclavicular block versus all other brachial plexus blocks for regional anaesthesia of the lower arm.
| infraclavicular block versus all other brachial plexus blocks for regional anaesthesia of the lower arm | ||||||
| Patient or population: patients with regional anaesthesia of the lower arm Settings: Intervention: infraclavicular block versus all other brachial plexus blocks | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | infraclavicular block versus all other brachial plexus blocks | |||||
| Adequate surgical anaesthesia ‐ At 30 minutes post‐block assessment interval | Study population | RR 0.88 (0.51 to 1.52) | 1051 (14 studies) | ⊕⊕⊕⊕ high | ||
| 871 per 1000 | 766 per 1000 (444 to 1000) | |||||
| Medium risk population | ||||||
| 868 per 1000 | 764 per 1000 (443 to 1000) | |||||
| Supplementation required to achieve adequate surgical anaesthesia | Study population | RR 0.95 (0.62 to 1.46) | 1412 (17 studies) | ⊕⊕⊕⊕ high | ||
| 135 per 1000 | 128 per 1000 (84 to 197) | |||||
| Medium risk population | ||||||
| 120 per 1000 | 114 per 1000 (74 to 175) | |||||
| Tourniquet pain | Study population | RR 0.66 (0.47 to 0.92) | 615 (8 studies) | ⊕⊕⊕⊕ high | ||
| 180 per 1000 | 119 per 1000 (85 to 166) | |||||
| Medium risk population | ||||||
| 157 per 1000 | 104 per 1000 (74 to 144) | |||||
| Onset time of adequate surgical anaesthesia (minutes) | The mean onset time of adequate surgical anaesthesia (minutes) in the intervention groups was 1.93 higher (0.23 to 3.64 higher) | 726 (9 studies) | ⊕⊕⊕⊝ moderate1 | |||
| Block performance time (minutes) ‐ multiple‐injection axillary block | The mean block performance time (minutes) ‐ multiple‐injection axillary block in the intervention groups was 2.67 lower (3.36 to 1.98 lower) | 391 (6 studies) | ⊕⊕⊕⊕ high | |||
| Block performance time (minutes) ‐ mid‐humeral block | The mean block performance time (minutes) ‐ mid‐humeral block in the intervention groups was 4.8 lower (6.04 to 3.57 lower) | 224 (2 studies) | ⊕⊕⊕⊝ moderate2 | |||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Subgroup analysis by method of localization showed that there was a significant difference in onset time in the studies using neurostimulation‐guided infraclavicular block but not in the studies using ultrasound‐guided infraclavicular block. 2 Only two studies in this review compared infraclavicular block to mid‐humeral block. Both were by the same investigators.