Journal article
Combination of shorter and longer-acting LA vs. longer-acting LA for brachial plexus block: Systematic review and meta-analysis of randomized clinical trials
Journal of clinical anesthesia, Vol.107, 112017
11/01/2025
DOI: 10.1016/j.jclinane.2025.112017
PMID: 40987240
Abstract
Combining shorter-acting local anesthetics (LA) with longer-acting ones should theoretically ensure a quick-onset block without compromising on the duration of blockade. We wanted to perform a review of literature evaluating combination of shorter-acting and longer-acting LA in comparison to long-acting LA alone when used for brachial plexus blocks in terms of block characteristics and efficacy.
Primary literature searches were performed in PubMed, Embase, and the Cochrane databases from their inception through October 26, 2023. Randomized clinical trials (RCTs) utilizing any combination of mixtures of a shorter and longer-acting LA (combination LA) compared to any single long-acting LA for brachial plexus block in adults were selected. The primary outcomes of interest were sensory and motor block onset times while secondary outcomes included duration of blockade, duration of analgesia and, the need for conversion to general anesthesia (GA).
A total of 4209 primary references were reviewed and after exclusions, 11 RCTs were included for data extraction. Pooled data showed that compared to long-acting LA, combination of LAs did not reduce the sensory onset time [MD (95 % CI) -0.44 min (−0.89; 0.02)] nor the motor onset [MD (95 % CI): 0.01 (−1.30 to 1.32)]. The combination group showed a shorter duration of sensory and motor blockade without differences in other secondary outcomes.
Our meta-analysis of RCTs indicate that combination of shorter and long acting LAs did not provide benefit in terms of onset time while leading to notably shorter durations of sensory and motor blockade compared to longer acting LA alone when used in brachial plexus blocks.
PROSPERO registration no.: CRD42023476579.
•Considerable debate exists regarding benefits of combining short and long acting local anesthetics to speed the onset of blockade in brachial plexus blocks.•In this systematic review and meta-analysis of randomized clinical trials we aimed to evaluate the block and analgesic profile of utilizing mixtures of short and long-acting local anesthetics compared to single long-acting local anesthetic agents when used for brachial plexus blocks.
Details
- Title: Subtitle
- Combination of shorter and longer-acting LA vs. longer-acting LA for brachial plexus block: Systematic review and meta-analysis of randomized clinical trials
- Creators
- Adeeb Oweidat - Mayo Clinic in FloridaCarla R. Hightower - The Ohio State UniversityVishal Uppal - Dalhousie UniversityHari Kalagara - Mayo Clinic in FloridaNada Sadek - Mayo Clinic in FloridaMelinda S. Seering - Mayo Clinic in FloridaChris Childs - University of Iowa, Hardin LibraryRakesh V. Sondekoppam - Stanford University
- Resource Type
- Journal article
- Publication Details
- Journal of clinical anesthesia, Vol.107, 112017
- DOI
- 10.1016/j.jclinane.2025.112017
- PMID
- 40987240
- NLM abbreviation
- J Clin Anesth
- ISSN
- 0952-8180
- eISSN
- 1873-4529
- Publisher
- Elsevier Inc
- Language
- English
- Electronic publication date
- 09/22/2025
- Date published
- 11/01/2025
- Academic Unit
- Anesthesia; Hardin Library
- Record Identifier
- 9984966332702771
Metrics
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