Regional Versus General Anesthesia and the Incidence of Unplanned Health Care Resource Utilization for Postoperative Pain After Wrist Fracture Surgery

Sunderland, Sarah; Yarnold, Cynthia H.; Head, Stephen; Osborn, Jill; Purssell, Andrew; Peel, John K.; Schwarz, Stephan

doi:10.1097/aap.0000000000000325

Cited by 78 publications

(55 citation statements)

References 21 publications

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“…The consistent occurrence of strong rebound pain in both groups when the block resolved during the first night was disappointing and a somewhat surprising result of our study, and several authors have discussed this phenomenon . This is in contrast to our previous study during inguinal hernia surgery which showed an excellent and improved analgesia profile for days after block resolution .…”

Section: Discussioncontrasting

confidence: 90%

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

et al. 2017

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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.

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Section: Discussioncontrasting

confidence: 90%

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

et al. 2017

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“…Participants had less rest pain at two postoperative hours after interscalene block than after shoulder block, but more pain 22 h later, although morphine consumption was similar. Increased pain after a regional block wears off – ‘rebound’ pain – is common, for which most evidence comes from retrospective case series . A similar pattern of delayed but increased pain was described in a randomised controlled trial of brachial plexus blockade vs. general anaesthesia for fixation of distal radius fracture .…”

Section: Discussionmentioning

confidence: 83%

A randomised controlled trial of shoulder block vs. interscalene brachial plexus block for ventilatory function after shoulder arthroscopy

et al. 2019

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Summary The shoulder block may impair ventilatory function and diaphragmatic movement less than the interscalene brachial plexus block. We randomly allocated 30 adults who underwent shoulder arthroscopy under general anaesthesia to ultrasound‐guided shoulder block or interscalene block with 20 ml bupivacaine 0.5%. The primary outcome, rate of ultrasound‐measured hemidiaphragmatic excursion < 25% of baseline 30 min after blockade, was reduced from 12/15 with brachial plexus block to 2/15 with shoulder block, a difference (95%CI) of 67% (40–93%), p < 0.001. The mean (SD) numeric rating scale pain scores at rest after shoulder block were higher than after interscalene block at two postoperative hours, 1.4 (1.2) vs. 0.3 (0.7), p = 0.02, but lower at 24 postoperative hours, 1.3 (1.3) vs. 3.4 (2.3), p = 0.008. Mean (SD) pain scores on movement in the shoulder and interscalene blocks were similar, with respective values of 1.9 (1.9) vs. 0.7 (1.2), p = 0.13 at two postoperative hours and 3.7 (2.3) vs. 5.3 (2.5), p = 0.41, at 24 postoperative hours.

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“…2. The self-reported highest pain scores were 5 (3,6) [median(IQR)]in the dexamethasone group and 8 (5,9) [median(IQR)] in the control group respectively (p < 0.001). The patients in dexamethasone group reported highest pain score at 19.7±6.6 h (mean±SD)since block administration while in the control group, the self-reported most severe pain happened at 14.7±4.8 h (mean±SD) after block.…”

Section: Resultsmentioning

confidence: 99%

“…However, rebound pain during nerve block wears off challenges the real bene t of this technique, especially in ambulatory surgery settings [4]. For patients receiving ambulatory surgery, the rebound pain is challenging to prevent or control, especially when it happens at home, which is a common cause of unplanned readmission to hospital [5]. Initially brought out by orthopaedic surgeons, rebound pain after nerve block are gaining more and more attention from anesthesiologists [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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

Fang

Shi

et al. 2020

Preprint

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Background：Rebound pain after single shot nerve block challenges the real benefit of this technique. We aimed to investigate whether perineural dexamethasone addition decreased the incidence of rebound pain after a single shot nerve block.Methods：We randomly allocated 132 patients scheduled for open reduction, and internal fixation of upper extremity closed fracture under single-shot peripheral nerve block and sedation into two groups. Patients in the dexamethasone group receiving nerve block with 0.375% ropivacaine and 8 mg dexamethasone while those in the control group received ropivacaine only. Sixty-three cases in the dexamethasone group and 60 cases in the control group were analyzed for the incidence of rebound pain in 48 h after the block administration. The primary outcome was the incidence of rebound pain in 48 h after the block administration. Secondary outcomes included the self-reported highest NRS score, pain intensity at 8h, 12h, 24h, 48h after the block, sufentanil consumption, sleep quality on the night of surgery, patient’s satisfaction to the pain therapy, blood glucose at 6h after the block, pain and paresthesia at 30 days after surgery.Results: The incidence of rebound pain was significantly lower in the dexamethasone group (7[11.1%] of 63 patients) than that in the control group (28[48.8%] of 60 patients; Relative risk (RR) is 0.238, 95% CI 0.113-0.504,p=0.001). Dexamethasone decreased the opioid consumption in 24 h after the surgery (p<0.001), improved the sleep quality score on the night of surgery(p=0.01) and satisfaction to the pain therapy(p=0.001). Multivariate logistic regression analysis showed that only group allocation was significantly associated with the occurrence of rebound pain[OR=0.131,95%CI (0.047-0.364)].Patients in the dexamethasone group reported later onset (19.7±6.6 h vs 14.7±4.8 h since block administration, mean±SD, p<0.001) lower peak NRS score [5 (3,6) vs 8 (5,9) , median(IQR), p<0.001] compared with those in the control group.Conclusions: Perineural administration of 8mg dexamethasone reduces rebound pain after a single-shot nerve block in patients receiving ORIF of upper limb fracture.Trial registration: This study was registered in Chinese Clinical Trial Registry (ChiCTR-IPR-17011365). The study was registered on May 11th , 2017. Retrospectively registered.

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Regional Versus General Anesthesia and the Incidence of Unplanned Health Care Resource Utilization for Postoperative Pain After Wrist Fracture Surgery

Cited by 78 publications

References 21 publications

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

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

A randomised controlled trial of shoulder block vs. interscalene brachial plexus block for ventilatory function after shoulder arthroscopy

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

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