Does Brachial Plexus Blockade Result in Improved Pain Scores After Distal Radius Fracture Fixation? A Randomized Trial

Abstract

Background Distal radius fractures are very common injuries and surgical treatment for them can be painful. Achieving early pain control may help improve patient satisfaction and improve functional outcomes. Little is known about which anesthesia technique (general anesthesia versus brachial plexus blockade) is most beneficial for pain control after distal radius fixation which could significantly affect patients' postoperative course and experience. Questions/Purposes We asked: (1) Did patients receiving general anesthesia or brachial plexus blockade have worse pain scores at 2, 12, and 24 hours after surgery? (2) Was there a difference in operative suite time between patients who had general anesthesia or brachial plexus blockade, and was there a difference in recovery room time? (3) Did patients receiving general anesthesia or brachial plexus blockade have higher narcotic use after surgery? (4) Do patients receiving general anesthesia or brachial plexus blockade have higher functional assessment scores after distal radius fracture repair at 6 weeks and 12 weeks after surgery? Methods A randomized controlled study was performed between February, 2013 and April, 2014 at a multicenter metropolitan tertiary-care referral center. Patients who presented with acute closed distal radius fractures (Orthopaedic Trauma Association 23A-C) were potentially eligible for inclusion. During the study period, 40 patients with closed, displaced, and unstable distal radius fractures were identified as meeting inclusion criteria and offered enrollment and randomization. Three patients (7.5%), all with concomitant injuries, declined to participate at the time of randomization as did one additional patient (2.5%) who chose not to participate, leaving a final sample of 36 participants. There were no dropouts after randomization, and analyses were performed according to an intention-totreat model. Patients were randomly assigned to one of two groups, general anesthesia or brachial plexus blockade, and among the 36 patients included, 18 were randomized to each group. Medications administered in the postanesthesia care unit were recorded. Patients were discharged receiving oxycodone and acetaminophen 5/325 mg for pain control, and VAS forms were provided. Patients were called at predetermined intervals postoperatively (2 hours, 4 hours, 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours) to gather pain scores, using the VAS, and to document the doses of analgesics consumed. In addition, patients had regular followups at 2 weeks, 6 weeks, and 12 weeks. Pain scores were again recorded using the VAS at these visits.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are...

Comparison of Postoperative Complications Associated With Anesthetic Choice for Surgery of the Hand

“…Overall, the authors found that regional anesthesia was more cost-effective than general anesthesia. Likewise, Galos et al 21 conducted a prospective, randomized trial comparing general and regional anesthesia for distal radius fractures. Those authors found that postoperative pain was reduced in patients treated with regional anesthesia, but that regional anesthesia was associated with "rebound pain" after the block wore off, leading to higher interim pain scores if not treated appropriately.…”

The effect of perineural dexamethasone on rebound pain after ropivacaine single-injection nerve block: A randomized controlled trial

“…Rebound pain following single-shot nerve block is a clinically relevant but less valued phenomenon which even diminishes the real bene t of peripheral nerve block in some surgeries [7,8,17].Patients undergoing surgical repair of distal radius fractures experienced different pain pro le after general anaesthesia compared with a peripheral nerve block. Although patients with brachial plexus block had less pain immediately after the procedure, 12 h to 24 h later when the block wore off, their pain was higher than those in the general anaesthetic group [10].…”

“…Initially brought out by orthopaedic surgeons, rebound pain after nerve block are gaining more and more attention from anesthesiologists [6][7][8]. It has been reported after different kinds of surgeries, such as ankle fracture surgery under popliteal sciatic nerve block [9], distal radius fracture xation under brachial plexus block [10] and shoulder arthroscopy surgery under interscalene brachial plexus block [11].Understanding the mechanism and searching for strategies to prevent rebound pain is integral to the effective utilization of regional anaesthesia.…”

Anaesthesia for open wrist fracture surgery in adults/elderly

“…Galos et al 9 randomized patients to general anaesthesia (n=18) or plexus block (n=18) and followed postoperative pain 2, 4, 6, 12, 24, 48 and 72 hours after surgery. They found that the general anaesthesia group had more pain 2 hours postoperatively, but regional anaesthesia experienced more pain 12 and 24 hours after surgery, termed “rebound pain”, as compared to the general anaesthesia patients.…”