Seventy-eight patients with distal forearm fractures were randomized to ultrasound-guided supraclavicular block (UGSCB) with ropivacaine (n=39) or Bier block (BB) with lignocaine/prilocaine (n=39). The primary outcome was patient-reported maximal pain during closed reduction (10-cm VAS; noninferiority margin 2 cm). Secondary outcomes included 1-hour pain, patient satisfaction, ED length of stay, opioid use, adverse events, rescue interventions, and follow-up pain/satisfaction at 24–72 hours. Overall, the results showed UGSCB was noninferior to BB for maximal pain and produced lower 1-hour pain. Safety, satisfaction, ED stay, and opioid use were similar. These findings suggest UGSCB is a safe, effective alternative to BB that may confer prolonged early analgesia after reduction