• An Teunkens, Kristien Vermeulen, Ann Belmans, Ilse Degreef, Marc Van de Velde, and Steffen Rex.
• From the Department of Anesthesiology, University Hospitals Leuven, Herestraat (AT, KV, MV de V, SR), I-Biostat, KU Leuven- University of Leuven, Kapucijnenvoer (AB), Department of Orthopedics, University Hospitals Leuven, Herestraat (ID) and Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Herestraat, Leuven, Belgium (AT, MV de V, SR).
• Eur J Anaesthesiol. 2020 Oct 1; 37 (10): 847-856.

BackgroundIntravenous regional anesthesia (IVRA) and the axillary brachial plexus block are popular alternatives to general anaesthesia in ambulatory hand surgery. Although both have proven their effectiveness, patients' preferences have never been evaluated.ObjectivesWe investigated patient satisfaction with both techniques and hypothesised that satisfaction after IVRA is noninferior compared with axillary brachial plexus block.DesignA prospective, randomised controlled trial.SettingAmbulatory surgical day care centre, University Hospitals of Leuven, Belgium, from September 2016 to November 2017.PatientsOne hundred and twenty adults undergoing minor ambulatory hand surgery were included in this study.InterventionPatients received either IVRA with 300 mg lidocaine or an axillary block with 280 mg mepivacaine.Main Outcome MeasuresThe primary endpoint was the evaluation of patient satisfaction using the 'Evaluation du Vécu de l'Anésthesie Locoregional' (EVAN-LR) questionnaire. Secondary outcomes included different procedural times, block quality, tourniquet discomfort, the incidence of block failure and postoperative nausea and vomiting (PONV), the severity of postoperative pain and the need for postoperative analgesics during the first 24 h.ResultsNoninferiority of IVRA was shown for the median [IQR] total score on the EVAN-LR questionnaire, IVRA-group: 92 [87 to 96] vs. axillary brachial plexus block-group: 91[87 to 97]; Hodges--Lehmann estimator (95% confidence interval (CI)] for the shift: -0.25 (-2.60 to 2.20). Induction of anaesthesia and time to discharge, requiring partial recovery of the motor block, were significantly longer in the axillary brachial plexus block group. The IVRA-group had a lower block quality, a higher incidence of tourniquet-discomfort and higher median intra-operative and postoperative pain scores on day 0; 0 [0 to 2] vs. 0 [0 to 0] and 0.8 [0 to 1.8] vs. 0 [0 to 0.25], respectively, but no increase in the need for supplementary analgesics or conversion rate to general anaesthesia.ConclusionIVRA and axillary brachial plexus block result in comparably high patient satisfaction in ambulatory hand surgery.Clinical Trial RegistrationEudraCT 2016-002325-11.

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