De Jose Maria 2008.

Methods	Randomized controlled trial
Participants	N = 80; paediatric; ASA 1‐2; average age 8‐9 yrs; 56 male, 24 female; elective upper limb surgery, Spanish study
Interventions	Infraclavicular block. Localization method: ultrasound using an out‐of‐plane approach with probe placed parallel to clavicle. Endpoint for injection: local anaesthetic spread around the plexus. Single‐injection through needle. Supraclavicular block. localization method: ultrasound using an in‐plane approach with probe in a coronal‐oblique plane. Endpoint for injection: local anaesthetic spread around the plexus. Single‐injection through needle. Injectate in both blocks: ropivacaine 0.5% in a volume up to 0.5ml/kg. Total volume was that needed to achieve adequate local anaesthetic spread around the plexus. This was 6±2 ml in the supraclavicular group Sedation for block and intraoperatively: all patients received a general anaesthetic before the block: 1 MAC sevoflurane in 50% oxygen/air. Fentanyl was given if heart rate or blood pressure increased by 10% or more
Outcomes	Block success, defined as no need for intraoperative fentanyl Block performance time, defined as time from first needle insertion to removal at end of the block. Reported as mean (range) Duration of sensory block, defined as time from brachial plexus puncture to first dose of rescue analgesia after the first 4 postoperative hours Duration of motor block, defined as time from brachial plexus puncture to first movement of fingers or wrist Complications: pneumothorax, Horner's syndrome, neurological deficits. The last was assessed at a 1 week follow‐up visit
Notes	Surgery started within 15 min of block. This may have reduced success rates. Two patients in the infraclavicular group had block procedure abandoned after arterial puncture. All outcomes except vascular puncture were analysed on an available‐case basis (N=38). Block performance times reported as mean, range and 95% CI for difference of means. Standard deviation calculated from this data, and also requested from author. Duration of sensory block was only reported for the supraclavicular group. Additional data requested from author.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: “80 children…were prospectively randomized into two groups…” No further details provided
Allocation concealment (selection bias)	Unclear risk	Not stated in text
Blinding (performance bias and detection bias) All outcomes	Unclear risk	No mention of blinding of patients or outcome assessors in text
Incomplete outcome data (attrition bias) All outcomes	Low risk	Two patients in the infraclavicular group had block procedure abandoned after arterial puncture. All outcomes except vascular puncture were analysed on an available‐case basis (N=38)
Selective reporting (reporting bias)	Unclear risk	No data reported on duration of sensory and motor block, or on volume of local anaesthetic injected in the infraclavicular group. These are outcomes of lesser importance
Other bias	High risk	Timing for measurement of outcomes may have been inappropriate ‐ 15 min is too short a time for assessment of block efficacy in the reviewers' opinion The ultrasound‐guided infraclavicular technique was an unusual one – out‐of‐plane – which may have contributed to the incidence of vascular puncture, which in turn led to abandonment and classification of the block as “failed” in these patients