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Authors: HassaninJalil1‡, FlorencePolfliet1‡, KristofNijs1, LiesbethBruckers2, GerritDeWachter3, InaCallebautI1,4, LeneSalimans1, MarcVandeVelde5,6, BjörnStessel1,4 Hospital/Institute: 1. Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium, 2. I-Biostat, Data Science Institute, Hasselt University, Hasselt, Belgium, 3. Department of Orthopedic Surgery, Jessa Hospital, Hasselt, Belgium, 4. Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium, 5. Department of Cardiovascular Sciences, KULeuven, Leuven, Belgium, 6. Department of Anaesthesiology, University Hospital, Leuven, Belgium ‡ These authors share first authorship on this work. *bjorn.stessel@jessazh.be Objective: This study aimed to investigate if ultrasound-guided forearm nerve block is superior to forearm IVRA in producing a surgical block in patients undergoing carpal tunnel release. Background: With the ultrasound, nerve blocks are now more reliable and safer to perform. Consequently, ultrasound-guided proximal brachial plexus blockade is considered the gold standard in regional anaesthesia during distal upper extremity surgery [1]. Distal peripheral nerve blocks provide extra advantages such as the avoidance of complications like pneumothorax and phrenic paralysis. Second, these distal peripheral blocks can preserve the motor function of the digits as well as the motor function of the more proximal muscles [2]. Compared to general anaesthesia or intravenous regional anaesthesia (IVRA), the use of a block room to perform peripheral nerve block techniques (outside of the operating room) may improve operating theatre efficiency [3]. This randomized controlled superiority trial was set out to compare ultrasound-guided forearm median and ulnar nerve block and forearm IVRA in patients undergoing carpal tunnel release. Methods: In this observer-blinded, randomized controlled superiority trial, 100 patients undergoing carpal tunnel release were randomized to receive ultrasound-guided forearm nerve block (n = 50) or forearm IVRA (n = 50). The primary outcome was anaesthetic efficacy evaluated by classifying the blocks as complete vs incomplete. Complete anaesthesia was defined as total sensory block, incomplete anaesthesia as mild pain requiring more analgesics or need of general anaesthesia. Pain intensity on a numeric rating scale (0–10) was recorded. Surgeon satisfaction with haemostasis, surgical time, and OR stay time were recorded. Patient satisfaction with the quality of the block was assessed at POD 1. This study is reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement Results: In total, 43 (86%) of the forearm nerve blocks were evaluated as complete, compared to 33 (66%) of the forearm IVRA (p = 0.019). After the forearm nerve block, pain intensity was lower at discharge (-1.76 points lower, 95% CI (-2.92, -0.59), p = 0.0006) compared to patients treated with forearm IVRA. No differences in pain experienced at the start of the surgery, during surgery, and at POD1, nor in surgical time or total OR stay was observed between groups. Surgeon (p = 0.0016) and patient satisfaction (p = 0.0023) were slightly higher after forearm nerve block. Conclusions: An ultrasound-guided forearm nerve block is superior compared to forearm IVRA in providing a surgical block in patients undergoing carpal tunnel release