Cochrane · systematic review · CD003842
Single, double or multiple‐injection techniques for non‐ultrasound guided axillary brachial plexus block in adults undergoing surgery of the lower arm
Chin, KJ, Cubillos, JE, Alakkad, H · Cochrane Database of Systematic Reviews · 2016 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
21
current version
GRADE rated
20
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 1 · 4.8%Very low 0 · 0%Low 7 · 33.3%Moderate 6 · 28.6%High 7 · 33.3%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyDouble versus single‐injection technique
Population: adult patients undergoing hand, wrist or forearm surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary anaesthesia failure (incomplete sensory block) Double vs single‐injection technique | RR 0.55 [0.34, 0.89] | 9 studies · 527 participants | High |
Secondary analgesia failure ‐ intraoperative sedation required Double vs single‐injection technique | RR 0.64 [0.31, 1.31] | 2 studies · 129 participants | Moderate Downgraded: imprecision |
Secondary analgesia failure ‐ tourniquet pain Double vs single‐injection technique | RR 0.58 [0.22, 1.52] | 2 studies · 104 participants | Moderate Downgraded: imprecision |
Complete failure of block3 Double vs single‐injection technique | RR 1.29 [0.33, 5.01] | 7 studies · 368 participants | Low Downgraded: imprecision |
Time to readiness for surgery4 Double vs single‐injection technique | no estimate extracted | 0 studies · 0 participants | Ungraded |
Intravascular injection Double vs single‐injection technique | RR 4.15 [0.46, 37.13] | 2 studies · 90 participants | Low Downgraded: imprecision |
Adverse effects lasting more than 24 hours5 Double vs single‐injection technique | no estimate extracted | 2 studies · 119 participants | Low Downgraded: imprecision |
Multiple versus single‐injection technique
Population: adult patients undergoing hand, wrist or forearm surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary anaesthesia failure Multiple vs single‐injection technique | RR 0.25 [0.14, 0.42] | 9 studies · 712 participants | High |
Secondary analgesia failure ‐ intraoperative sedation required Multiple vs single‐injection technique | RR 0.7 [0.41, 1.19] | 5 studies · 482 participants | High |
Secondary analgesia failure ‐ tourniquet pain Multiple vs single‐injection technique | RR 0.97 [0.3, 3.11] | 4 studies · 379 participants | High |
Complete failure of block1 Multiple vs single‐injection technique | RR 0.31 [0.03, 2.71] | 7 studies · 484 participants | Moderate Downgraded: imprecision, inconsistency |
Time to readiness for surgery (minutes) Multiple vs single‐injection technique | no estimate extracted | 2 studies · 206 participants | Low Downgraded: imprecision, inconsistency |
Intravascular injection Multiple vs single‐injection technique | RR 1.35 [0.2, 9.06] | 4 studies · 352 participants | Moderate Downgraded: imprecision, inconsistency |
Adverse effects lasting more than 24 hours5 Multiple vs single‐injection technique | no estimate extracted | 3 studies · 244 participants | Low Downgraded: imprecision, inconsistency |
Multiple versus double‐injection technique
Population: adult patients undergoing hand, wrist or forearm surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary anaesthesia failure Multiple vs double‐injection technique | RR 0.27 [0.19, 0.39] | 12 studies · 966 participants | High |
Secondary analgesia failure ‐ intraoperative sedation required Multiple vs double‐injection technique | RR 0.75 [0.55, 1.03] | 7 studies · 716 participants | High |
Secondary analgesia failure ‐ tourniquet pain Multiple vs double‐injection technique | RR 0.53 [0.33, 0.84] | 7 studies · 719 participants | High |
Complete failure of block1 Multiple vs double‐injection technique | RR 0.24 [0.04, 1.41] | 9 studies · 630 participants | Low Downgraded: imprecision, inconsistency |
Time to readiness for surgery4 Multiple vs double‐injection technique | no estimate extracted | 5 studies · 524 participants | Moderate Downgraded: imprecision, inconsistency |
Intravascular injection Multiple vs double‐injection technique | RR 0.69 [0.32, 1.49] | 7 studies · 676 participants | Moderate Downgraded: imprecision, inconsistency |
Adverse effects lasting more than 24 hours5 Multiple vs double‐injection technique | no estimate extracted | 6 studies · 510 participants | Low Downgraded: imprecision, inconsistency |
Double versus single‐injection technique
Population: Adult patients undergoing hand, wrist or forearm surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary anaesthesia failure Double vs single‐injection technique | RR 0.51 [0.3, 0.85] | 8 studies · 497 participants | Moderate |
Secondary analgesia failure: Intraoperative sedation required Double vs single‐injection technique | RR 0.64 [0.31, 1.31] | 2 studies · 129 participants | Low |
Secondary analgesia failure : Tourniquet pain Double vs single‐injection technique | RR 0.58 [0.22, 1.52] | 2 studies · 104 participants | Low |
Complete failure of block1 Double vs single‐injection technique | RR 1.29 [0.33, 5.01] | 6 studies · 338 participants | Very low |
Time to readiness for surgery2 (minutes) Double vs single‐injection technique | no estimate extracted | NR | Very low |
Intravascular injection Double vs single‐injection technique | RR 5.86 [0.25, 137.66] | 1 study · 60 participants | Very low |
Adverse effects lasting more than 24 hours3 Double vs single‐injection technique | RR 1.25 [0.27, 5.89] | 2 studies · 119 participants | Very low |
Multiple versus single‐injection technique
Population: Adult patients undergoing hand, wrist or forearm surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary anaesthesia failure Multiple vs single‐injection technique | RR 0.25 [0.14, 0.44] | 8 studies · 682 participants | Moderate |
Secondary analgesia failure: Intraoperative sedation required Multiple vs single‐injection technique | RR 0.7 [0.41, 1.19] | 5 studies · 482 participants | Low |
Secondary analgesia failure : Tourniquet pain Multiple vs single‐injection technique | RR 0.97 [0.3, 3.11] | 4 studies · 379 participants | Low |
Complete failure of block1 Multiple vs single‐injection technique | RR 0.31 [0.03, 2.71] | 6 studies · 454 participants | Very low |
Time to readiness for surgery2 (minutes) Multiple vs single‐injection technique | no estimate extracted | 2 studies · 206 participants | Low |
Intravascular injection Multiple vs single‐injection technique | RR 0.87 [0.09, 8.44] | 3 studies · 322 participants | Very low |
Adverse effects lasting more than 24 hours3 Multiple vs single‐injection technique | RR 0.25 [0.02, 2.59] | 3 studies · 244 participants | Very low |
Multiple versus double‐injection technique
Population: Adult patients undergoing hand, wrist or forearm surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary anaesthesia failure Multiple vs double‐injection technique | RR 0.28 [0.2, 0.4] | 11 studies · 936 participants | Moderate |
Secondary analgesia failure: Intraoperative sedation required Multiple vs double‐injection technique | RR 0.75 [0.55, 1.03] | 7 studies · 716 participants | Low |
Secondary analgesia failure : Tourniquet pain Multiple vs double‐injection technique | RR 0.53 [0.33, 0.84] | 7 studies · 719 participants | Moderate |
Complete failure of block1 Multiple vs double‐injection technique | RR 0.24 [0.04, 1.41] | 8 studies · 600 participants | Very low |
Time to readiness for surgery2 (minutes) Multiple vs double‐injection technique | no estimate extracted | 5 studies · 524 participants | Low |
Intravascular injection Multiple vs double‐injection technique | RR 0.55 [0.23, 1.32] | 4 studies · 476 participants | Very low |
Adverse effects lasting more than 24 hours3 Multiple vs double‐injection technique | RR 0.2 [0.02, 1.64] | 6 studies · 510 participants | Very low |
Double versus single‐injection technique
Population: Adult patients undergoing hand, wrist or forearm surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary anaesthesia failure Double vs single‐injection technique | RR 0.51 [0.3, 0.85] | 8 studies · 497 participants | Moderate |
Secondary analgesia failure: Intraoperative sedation required Double vs single‐injection technique | RR 0.64 [0.31, 1.31] | 2 studies · 129 participants | Low |
Secondary analgesia failure : Tourniquet pain Double vs single‐injection technique | RR 0.58 [0.22, 1.52] | 2 studies · 104 participants | Low |
Complete failure of block1 Double vs single‐injection technique | RR 1.29 [0.33, 5.01] | 6 studies · 338 participants | Very low |
Time to readiness for surgery2 (minutes) Double vs single‐injection technique | no estimate extracted | NR | Very low |
Intravascular injection Double vs single‐injection technique | RR 5.86 [0.25, 137.66] | 1 study · 60 participants | Very low |
Adverse effects lasting more than 24 hours3 Double vs single‐injection technique | RR 1.25 [0.27, 5.89] | 2 studies · 119 participants | Very low |
Multiple versus single‐injection technique
Population: Adult patients undergoing hand, wrist or forearm surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary anaesthesia failure Multiple vs single‐injection technique | RR 0.28 [0.16, 0.48] | 7 studies · 632 participants | Moderate |
Secondary analgesia failure: Intraoperative sedation required Multiple vs single‐injection technique | RR 0.7 [0.41, 1.19] | 5 studies · 482 participants | Low |
Secondary analgesia failure : Tourniquet pain Multiple vs single‐injection technique | RR 0.97 [0.3, 3.11] | 4 studies · 379 participants | Low |
Complete failure of block1 Multiple vs single‐injection technique | RR 0.44 [0.01, 17.76] | 5 studies · 404 participants | Very low |
Time to readiness for surgery2 (minutes) Multiple vs single‐injection technique | no estimate extracted | 2 studies · 206 participants | Low |
Intravascular injection Multiple vs single‐injection technique | RR 0.87 [0.09, 8.44] | 3 studies · 322 participants | Very low |
Adverse effects lasting more than 24 hours3 Multiple vs single‐injection technique | RR 0.25 [0.02, 2.59] | 3 studies · 244 participants | Very low |
Multiple versus double‐injection technique
Population: Adult patients undergoing hand, wrist or forearm surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Primary anaesthesia failure Multiple vs double‐injection technique | RR 0.28 [0.2, 0.4] | 11 studies · 936 participants | Moderate |
Secondary analgesia failure: Intraoperative sedation required Multiple vs double‐injection technique | RR 0.75 [0.55, 1.03] | 7 studies · 716 participants | Low |
Secondary analgesia failure : Tourniquet pain Multiple vs double‐injection technique | RR 0.53 [0.33, 0.84] | 7 studies · 719 participants | Moderate |
Complete failure of block1 Multiple vs double‐injection technique | RR 0.24 [0.04, 1.41] | 8 studies · 600 participants | Very low |
Time to readiness for surgery2 (minutes) Multiple vs double‐injection technique | no estimate extracted | 5 studies · 524 participants | Low |
Intravascular injection Multiple vs double‐injection technique | RR 0.55 [0.23, 1.32] | 4 studies · 476 participants | Very low |
Adverse effects lasting more than 24 hours3 Multiple vs double‐injection technique | RR 0.2 [0.02, 1.64] | 6 studies · 510 participants | Very low |