Skip to main content
. 2013 Aug 28;2013(8):CD005487. doi: 10.1002/14651858.CD005487.pub3

Minville 2006.

Methods Randomized controlled trial
Participants N = 104; adult; 58 male, 46 female; ASA 1‐3; trauma surgery on inferior third of humerus to hand; French study
Interventions

  1. Infraclavicular block (Minville 2005). Localization method: surface landmarks ‐ 1cm medial to the coracoid process and 1cm below the clavicle. Endpoint for injection: motor response in the distribution of MCN and 1 of 3 other nerve distributions (MN/UN/RN) to neurostimulation at 0.3‐0.5mA. Dual‐injection through needle (10ml at MCN, 30ml at other site).

  2. Humeral block. Localization method: surface landmarks ‐ axillary arterial pulsation at the junction of proximal and middle third of arm. Endpoint for injection: motor response in all 4 nerve distributions (MCN/MN/UN/RN) to neurostimulation at 0.3‐0.5mA. Quadruple‐injection through needle, equally divided.


Injectate in both blocks: lidocaine 1.5% + epinephrine 1:200,000 in volume of 40mls
Sedation for block: IV sufentanil 0.1 μg/kg
Intraoperative sedation: none
Outcomes

  1. Block success, defined as absent sensation of cold and pinprick in 4 nerve distributions (RN, MN, UN, MCN) at 30 min

  2. Sensory block to cold and pinprick, scored as scored as 0 (none), 1 (analgesia), 2 (anaesthesia) in each nerve distribution (RN/UN/MN/MCN/AN/MBCN/MABCN). Assessed every 5 min up to 30 min post‐block

  3. Block performance time, defined as needle insertion to withdrawal

  4. Onset time of sensory block, defined as end of procedure to analgesia in 4 nerve distributions (RN, MN, UN, MCN)

  5. Duration of block (not defined)

  6. Pain associated with block, and further subdivided according to components (skin transfixion, needle redirection, local anaesthetic injection causing paraesthesia or dysaesthesia, electrolocation causing movement‐associated pain), and assessed by visual analogue score (VAS)

  7. Patient satisfaction post‐surgery, scored on scale of 0‐5

  8. Preference for similar block in future

  9. Complications (vascular puncture, systemic local anaesthetic toxicity, recurrent laryngeal nerve palsy, phrenic nerve palsy, paraesthesia, Horner's syndrome, pneumothorax)
Notes Patient satisfaction was converted to a dichotomous outcome as follows: satisfied = score of 4 or 5, dissatisfied = score of 3 or less.
It is not clear how they surveyed for complications. The list mentioned above was stated in the Results section and not in the Methods.
Authors did not report the incidences of sensory block in the individual nerve distributions at the various time intervals. This data was not available on request.
Abbreviations: AN = axillary nerve, MABCN = medial antebrachial cutaneous nerve, MBCN = medial brachial cutaneous nerve, MCN = musculocutaneous nerve, MN = medial nerve, RN = radial nerve, UN = ulnar nerve
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk No mention of randomization method in text
Allocation concealment (selection bias) Unclear risk No mention of randomization method in text
Blinding (performance bias and detection bias) 
 All outcomes Unclear risk No mention of blinding of the patient or outcome assessor in text
Incomplete outcome data (attrition bias) 
 All outcomes Low risk Complete follow‐up for all patients
Selective reporting (reporting bias) Low risk All pre‐specified outcomes reported
Other bias Low risk None identified