What do systematic reviews say?

Radiotherapy vs full axillary surgery

Radiotherapy alone leads to lower local recurrence compared with full axillary surgery (high certainty).

• Axillary treatment for operable primary breast cancer 2017 · Cochrane Headline outcomes only
  HR 0.8 [0.64, 0.99]
  4 studies · 22256 participants
  High

Sentinel node biopsy vs full axillary surgery

Sentinel node biopsy showed no clear difference in all‐cause mortality compared with full axillary surgery (moderate certainty).

• Axillary treatment for operable primary breast cancer 2017 · Cochrane Headline outcomes only
  HR 1.05 [0.89, 1.25]
  3 studies · 6352 participants
  Moderate

Sentinel node biopsy vs full axillary surgery

Sentinel node biopsy may leads to lower lymphoedema Patient‐reported lymphoedema of any severity compared with full axillary surgery (low certainty).

• Axillary treatment for operable primary breast cancer 2017 · Cochrane Headline outcomes only
  OR 0.33 [0.15, 0.86]
  3 studies · 815 participants
  Low

Sentinel node biopsy vs full axillary surgery

It is very uncertain whether sentinel node biopsy changes subjective arm movement impairment compared with full axillary surgery (very low certainty).

• Axillary treatment for operable primary breast cancer 2017 · Cochrane Headline outcomes only
  OR 0.38 [0.22, 0.67]
  2 studies · 877 participants
  Very low

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

Multiple showed no clear difference in intravascular injection 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 1.35 [0.2, 9.06]
  4 studies · 352 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
  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

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

Multiple showed no clear difference in intravascular injection compared with double‐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 0.69 [0.32, 1.49]
  7 studies · 676 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

Double showed no clear difference in intravascular injection 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 4.15 [0.46, 37.13]
  2 studies · 90 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
  2 studies · 119 participants
  Low