What do systematic reviews say?

4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

4% articaine, 1:100,000 epinephrine showed no clear difference in adverse effects: pain on injection (solution deposition),… compared with 2% lidocaine, 1:100,000 epinephrine (moderate certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes

  0-1 minute following needle insertion
  MD 4.74 [-1.98, 11.46]
  3 studies · 157 participants
  Moderate

0.5% bupivacaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

4% articaine, 1:100,000 epinephrine probably leads to higher adverse effects: pain following injection, Heft-Parker VAS 0-170 mm compared with 2% lidocaine, 1:100,000 epinephrine (moderate certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes

  Measured at the time anaesthesia wore off
  MD 6.41 [1.01, 11.8]
  3 studies · 156 participants
  Moderate

Peribulbar vs retrobulbar

Peribulbar showed no clear difference in need for additional injection Number of additional injections compared with retrobulbar (low certainty).

• Peribulbar versus retrobulbar anaesthesia for cataract surgery 2015 · Cochrane Headline outcomes only
  RR 1.54 [0.91, 2.6]
  4 studies · 1029 participants
  Low

Infraclavicular block vs all other brachial plexus blocks

• Infraclavicular brachial plexus block for regional anaesthesia of the lower arm 2013 · Cochrane Headline outcomes only
  no estimate extracted
  6 studies · 391 participants
  High

Double vs single‐injection technique

Double leads to lower primary anaesthesia failure (incomplete sensory block) compared with single‐injection technique (high certainty).

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  RR 0.55 [0.34, 0.89]
  9 studies · 527 participants
  High

Multiple vs single‐injection technique

Multiple showed no clear difference in secondary analgesia failure ‐ tourniquet pain compared with single‐injection technique (high certainty).

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  RR 0.97 [0.3, 3.11]
  4 studies · 379 participants
  High

Multiple vs single‐injection technique

Multiple showed no clear difference in complete failure of block1 compared with single‐injection technique (moderate certainty).

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  RR 0.31 [0.03, 2.71]
  7 studies · 484 participants
  Moderate

Multiple vs single‐injection technique

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 206 participants
  Low

Multiple vs single‐injection technique

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  no estimate extracted
  3 studies · 244 participants
  Low

Multiple vs double‐injection technique

Multiple leads to lower primary anaesthesia failure compared with double‐injection technique (high certainty).

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  RR 0.27 [0.19, 0.39]
  12 studies · 966 participants
  High

Multiple vs double‐injection technique

Multiple showed no clear difference in secondary analgesia failure ‐ intraoperative sedation required compared with double‐injection technique (high certainty).

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  RR 0.75 [0.55, 1.03]
  7 studies · 716 participants
  High

Multiple vs double‐injection technique

Multiple leads to lower secondary analgesia failure ‐ tourniquet pain compared with double‐injection technique (high certainty).

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  RR 0.53 [0.33, 0.84]
  7 studies · 719 participants
  High

Multiple vs double‐injection technique

Multiple showed no clear difference in complete failure of block1 compared with double‐injection technique (low certainty).

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  RR 0.24 [0.04, 1.41]
  9 studies · 630 participants
  Low

Multiple vs double‐injection technique

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  no estimate extracted
  5 studies · 524 participants
  Moderate

Double vs single‐injection technique

Double showed no clear difference in secondary analgesia failure ‐ intraoperative sedation required compared with single‐injection technique (moderate certainty).

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  RR 0.64 [0.31, 1.31]
  2 studies · 129 participants
  Moderate

Multiple vs double‐injection technique

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  no estimate extracted
  6 studies · 510 participants
  Low

Double vs single‐injection technique

Double showed no clear difference in secondary analgesia failure ‐ tourniquet pain compared with single‐injection technique (moderate certainty).

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  RR 0.58 [0.22, 1.52]
  2 studies · 104 participants
  Moderate

Double vs single‐injection technique

Double showed no clear difference in complete failure of block3 compared with single‐injection technique (low certainty).

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  RR 1.29 [0.33, 5.01]
  7 studies · 368 participants
  Low

Double vs single‐injection technique

• Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults… 2016 · Cochrane Headline outcomes only
  no estimate extracted
  0 studies · 0 participants
  GRADE not reported