Pre‐operative brachial plexus block compared with an identical block performed at the end of surgery: a prospective, double‐blind, randomised clinical trial

Abstract

We evaluated whether pre-emptive analgesia with a pre-operative ultrasound-guided infraclavicular brachial plexus block resulted in better postoperative analgesia than an identical block performed postoperatively. Fifty-two patients undergoing fixation of a fractured radius were included. All patients received general anaesthesia with remifentanil and propofol. Patients were randomly allocated into two groups: a pre-operative block or a postoperative block with 0.5 ml.kg ropivacaine 0.75%. After surgery, all patients received regular paracetamol plus opioids for breakthrough pain. Mean (SD) time to first rescue analgesic after emergence from general anaesthesia was 544 (217) min in the pre-operative block group compared with 343 (316) min in the postoperative block group (p = 0.015). Postoperative pain scores were higher and more patients required rescue analgesia during the first 4 h after surgery in the postoperative block group. There were no significant differences in plasma stress mediators between the groups. Analgesic consumption was lower at day seven in the pre-operative block group. Pain was described as very strong at block resolution in 27 (63%) patients and 26 (76%) had episodes of mild pain after 6 months. We conclude that a pre-operative ultrasound-guided infraclavicular brachial plexus block provides longer and better analgesia in the acute postoperative period compared with an identical postoperative block in patients undergoing surgery for fractured radius.

Analgesic effect of intravenous dexamethasone after volar plate surgery for distal radius fracture with brachial plexus block anaesthesia: a prospective, double‐blind randomised clinical trial*

“…similar to that in our previous study, opioid consumption and duration of strong pain were less[8]. However, our hypothesis of significantly less pain (as assessed by pain scores, pain duration and need of opioid rescue after antiinflammatory prophylaxis with both dexamethasone and etoricoxib) was supported[8].…”

“…In our previous study on volar plate fixations after distal radius fractures, we found a high incidence (63%) of very strong breakthrough pain upon brachial plexus block resolution. Also, 76% of patients reported pain at 6 months after the operation, although characterised as mild in all but one case [8].…”

Analgesic benefits and clinical role of the posterior suprascapular nerve block in shoulder surgery: a systematic review, meta‐analysis and trial sequential analysis

“…This complexity of innervation of the shoulder joint and its surrounding tissues seems to provide an anatomical explanation to the failure of the isolated SSNB to provide clinically important analgesic benefits following shoulder surgery. Indeed, although a combined pre‐operative axillary nerve block and SSNB has been proposed as an ISB alternative capable of providing adequate postoperative pain control , our findings did not clinically support this proposition. Although unexpected, this conclusion may be an example of skewed attention whereby researchers, including ourselves, have focused primarily on anaesthetising the shoulder joint, giving less attention to the surrounding tissues.…”

Anaesthesia for open wrist fracture surgery in adults/elderly

“…Holmberg et al 11 studied 52 patients with fractured radius. The study compared pre- and post-operative block, in both groups combined with general anaesthesia total intravenous anaesthesia (TIVA).…”