{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T20:28:02Z","timestamp":1785356882685,"version":"3.55.0"},"reference-count":22,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2020,2,20]]},"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background and objectives<\/jats:title>\n                  <jats:p>Circumferential (C) spread of local anesthetic around the nerve is recommended for a successful nerve block. We tested the hypothesis that C spread produces a more complete block than non-circumferential (NC) spread.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We randomized 124 patients undergoing open carpal tunnel syndrome surgery to receive C or NC spread ultrasound-guided median and ulnar nerve blocks. The primary outcome was the proportion of patients who developed complete sensory block measured at 5, 15 and 30\u2009min. The loss of cold sensation was graded as: 0 (complete block), 1 (incomplete block), or 2 (no block). Secondary outcomes included motor block, nerve swelling and adverse events.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In group C, complete sensory block at 5\u2009min was 2.4 (95% CI 1.0 to 5.7; p=0.04) times more frequent in the median nerve and 3.0 (95% CI 1.2 to 7.2; p=0.01) times more frequent in the ulnar nerve compared with group C. However, at 15 and 30\u2009min, it was similar between groups. Complete motor block was more frequent in group C than in group NC for both the median nerve: 1.5 (95% CI 1.1 to 2.2; p&lt;0.01) at 15\u2009min, 1.1 (95% CI 1.0 to 1.2; p=0.02) at 30\u2009min, and the ulnar nerve: 1.7 (95% CI 1.2 to 2.6; p&lt;0.01) at 15\u2009min, 1.2 (95% CI 1.0 to 1.4; p&lt;0.01) at 30\u2009min. The incidence of nerve swelling and adverse effects was similar between groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>C spread around the median and ulnar nerves at the level of the antecubital fossa generates more complete sensory and motor blocks compared with NC spread.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>EudraCT 2011-002608-34 and <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial results\" xlink:href=\"NCT01603680\">NCT01603680<\/jats:ext-link>\n                  <\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2019-101157","type":"journal-article","created":{"date-parts":[[2020,3,12]],"date-time":"2020-03-12T04:45:14Z","timestamp":1583988314000},"page":"362-366","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Comparison of the effectiveness of circumferential versus non-circumferential spread in median and ulnar nerve blocks. A double-blind randomized clinical trial"],"prefix":"10.1136","volume":"45","clinical-trial-number":[{"clinical-trial-number":"nct01603680","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2193-0907","authenticated-orcid":false,"given":"Paula","family":"Dieguez-Garcia","sequence":"first","affiliation":[{"name":"Anesthesiology, Complexo Hospitalario Universitario A Coru\u00f1a, A Coru\u00f1a, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Servando","family":"Lopez-Alvarez","sequence":"additional","affiliation":[{"name":"Anesthesiology, Complexo Hospitalario Universitario A Coru\u00f1a, A Coru\u00f1a, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Juncal","sequence":"additional","affiliation":[{"name":"Anesthesiology, Complexo Hospitalario Universitario A Coru\u00f1a, A Coru\u00f1a, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana M","family":"Lopez","sequence":"additional","affiliation":[{"name":"Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Sala-Blanch","sequence":"additional","affiliation":[{"name":"Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain"},{"name":"Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Catalonia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,3,11]]},"reference":[{"key":"2025101110440592000_45.5.362.1","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0b013e328356bb40"},{"key":"2025101110440592000_45.5.362.2","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1213\/01.ANE.0000184187.02887.24","article-title":"Peripheral nerve block techniques for ambulatory surgery","volume":"101","author":"Klein","year":"2005","journal-title":"Anesth Analg"},{"key":"2025101110440592000_45.5.362.3","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e3181d266f0"},{"key":"2025101110440592000_45.5.362.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2009.09.008"},{"key":"2025101110440592000_45.5.362.5","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e3181fa6b60"},{"key":"2025101110440592000_45.5.362.6","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e318217a6a1"},{"key":"2025101110440592000_45.5.362.7","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeu002"},{"key":"2025101110440592000_45.5.362.8","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181e3a06f"},{"key":"2025101110440592000_45.5.362.9","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.redar.2012.09.019","article-title":"[Ultrasound-guided block at the antecubital fossa for carpal tunnel syndrome surgery]","volume":"60","author":"Di\u00e9guez Garc\u00eda","year":"2013","journal-title":"Rev Esp Anestesiol Reanim"},{"key":"2025101110440592000_45.5.362.10","unstructured":"Aran ediciones . Ramas perif\u00e9ricas del plexo braquial. Madrid. Espa\u00f1a: Aran ediciones, 2015: 143\u201353."},{"key":"2025101110440592000_45.5.362.11","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e3181d28396"},{"key":"2025101110440592000_45.5.362.12","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aep097"},{"key":"2025101110440592000_45.5.362.13","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1213\/ANE.0000000000000462","article-title":"A prospective, randomized comparison between single- and multiple-injection techniques for ultrasound-guided subgluteal sciatic nerve block","volume":"119","author":"Yamamoto","year":"2014","journal-title":"Anesth Analg"},{"key":"2025101110440592000_45.5.362.14","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1111\/anae.13787","article-title":"Ultrasound-Guided approach to nerves (direct vs. tangential) and the incidence of intraneural injection: a cadaveric study","volume":"72","author":"Sermeus","year":"2017","journal-title":"Anaesthesia"},{"key":"2025101110440592000_45.5.362.15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2011.06619.x"},{"key":"2025101110440592000_45.5.362.16","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1111\/anae.13913","article-title":"Ultrasound-Guided block and the incidence of intraneural injection","volume":"72","author":"Szerb","year":"2017","journal-title":"Anaesthesia"},{"key":"2025101110440592000_45.5.362.17","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e31824bde5c"},{"key":"2025101110440592000_45.5.362.18","doi-asserted-by":"crossref","DOI":"10.1002\/ca.23442","article-title":"Another (internal) Epineurium: beyond the anatomical barriers of nerves","volume":"33","author":"Reina","year":"2020","journal-title":"Clin Anat"},{"key":"2025101110440592000_45.5.362.19","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e3181d25cfe"},{"key":"2025101110440592000_45.5.362.20","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200610000-00024"},{"key":"2025101110440592000_45.5.362.21","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3182276d10"},{"key":"2025101110440592000_45.5.362.22","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181e1d94c"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2019-101157","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T17:44:12Z","timestamp":1760204652000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2019-101157"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,11]]},"references-count":22,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,4,21]]},"published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1136\/rapm-2019-101157"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2019-101157","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,11]]}}}