Danelli 2012.

Methods	RCT, parallel design
Participants	50 participants, ASA I ‐ III, scheduled for elective coracoacromial ligament repair Excluded: < 18 yrs, > 85 yrs, unable to express informed consent, with known allergy to study medications, chronic opioid use, ipsilateral upper limb neurological deficits, or contraindications to continuous block placement
Interventions	Ultrasound versus nerve stimulation. Interscalene brachial plexus block for nerve roots of brachial plexus; blocked with 20 ml 1% lidocaine Ultrasound: 10 – 12 MHz linear probe (LOGIQ E), in‐plane approach; endpoint ‐ direct visualization of LA spread around nerve roots. Catheter inserted after injection of LA Nerve stimulation: pulse duration 0.2 ms, initial current 1 mA, frequency 2 Hz; endpoint ‐ stimulation of deltoid muscle motor responses at 0.5 mA. Stimulating perineural catheter was then inserted through the needle and advanced to maintain the adequate motor response at ≤ 0.4 mA.  LA injected in increments
Outcomes	Supplementation rate Complications Block onset time (given separately for axillary, radial and musculocutaneous nerves) Time to perform block ("time interval between first US scan and needle removal at end of block in Group US and as the time interval between identification of anatomical landmarks and needle removal at the end of the block in Group NS") Number of block attempts (skin punctures defined as any new needle insertion through the skin; needle redirections defined as any needle withdrawal with subsequent forward movement of 10mm) Participant discomfort
Notes	2 practitioners experienced in both techniques Registered in clinicaltrials.gov No numerical data presented for supplementation rate ‐ "There were no differences in the...requirements for GA" No denominator figures provided. Email request sent to authors, but as yet no reply.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated sequence of random numbers
Allocation concealment (selection bias)	Unclear risk	“sealed envelope technique” but no further details given
Blinding of participants and personnel (performance bias):adequacy of block, need for supplementation	High risk	Not possible to blind anaesthetist
Blinding of participants and personnel (performance bias):Complications	High risk	Not possible to blind anaesthetist
Blinding of participants and personnel (performance bias): time outcomes	High risk	Not possible to blind anaesthetist
Blinding of participants and personnel (performance bias): Patient discomfort	High risk	Not possible to blind anaesthetist
Blinding of outcome assessment (detection bias): adequacy of block, supplementation of block	Unclear risk	No details of who assessed this outcome
Blinding of outcome assessment (detection bias): Complications	Unclear risk	No details of who assessed this outcome
Blinding of outcome assessment (detection bias): time outcomes	Unclear risk	Some outcomes recorded by a nurse, but no details as to whether nurse was blinded
Blinding of outcome assessment (detection bias): Patient discomfort	Unclear risk	No details of whether participant blinded to group allocation
Incomplete outcome data (attrition bias) All outcomes	Low risk	No apparent losses
Selective reporting (reporting bias)	Low risk	Protocol details published in clinicaltrials.gov. NCT 00702416. Outcomes appear to be reported
Baseline characteristics	Low risk	Comparable
Funding sources	Low risk	None apparent
Operator expertise	Unclear risk	Only 2 practitioners, both experienced in both techniques