Infraclavicular nerve block reduces postoperative pain after distal radial fracture fixation: a randomized controlled trial

• Published in: BMC anesthesiology Vol. 20; no. 1; p. 130
• Main Authors: Wong, Stanley S, Chan, Wing S, Fang, Christian, Chan, Chi W, Lau, Tak W, Leung, Frankie, Cheung, Chi W
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28-05-2020; BioMed Central; BMC
• Subjects: Airway management; Analgesia; Analgesics; Anesthesia; Anesthetics; Blood pressure; Bone surgery; Clinical trials; Complications and side effects; Consumption data; Distal radial fracture fixation; Drug dosages; General anesthesia; Hospitals; Infraclavicular nerve block; Internal fixation; Morphine; Narcotics; Nausea; Pain; Pain management; Pain perception; Patient satisfaction; Postoperative pain; Postoperative period; Quality of life; Regional anesthesia; Surgery; Surgical outcomes; Ultrasonic imaging; Ultrasound; Vomiting; Wrist; General anesthesia; Postoperative pain; Regional anesthesia; Distal radial fracture fixation; Infraclavicular nerve block
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-020-01044-4

It is unclear whether regional anesthesia with infraclavicular nerve block or general anesthesia provides better postoperative analgesia after distal radial fracture fixation, especially when combined with regular postoperative analgesic medications. The aim of this study was to compare the postoperative analgesic effects of regional versus general anesthesia.
In this prospective, observer blinded, randomized controlled trial, 52 patients undergoing distal radial fracture fixation received either general anesthesia (n = 26) or regional anesthesia (infraclavicular nerve block, n = 26). Numerical rating scale pain scores, analgesic consumption, patient satisfaction, adverse effects, upper limb functional scores (Patient-Rated Wrist Evaluation, QuickDASH), health related quality of life (SF12v2), and psychological status were evaluated after surgery.
Regional anesthesia was associated with significantly lower pain scores both at rest and with movement on arrival to the post-anesthetic care unit; and at 1, 2, 24 and 48 h after surgery (p ≤ 0.001 at rest and with movement). Morphine consumption in the post-anesthetic care unit was significantly lower in the regional anesthesia group (p<0.001). There were no differences in oral analgesic consumption. Regional anesthesia was associated with lower incidences of nausea (p = 0.004), and vomiting (p = 0.050). Patient satisfaction was higher in the regional anesthesia group (p = 0.003). There were no long-term differences in pain scores and other patient outcomes.
Regional anesthesia with ultrasound guided infraclavicular nerve block was associated with better acute pain relief after distal radial fracture fixation, and may be preferred over general anesthesia.
Before subject enrollment, the study was registered at ClinicalTrials.gov (NCT03048214) on 9th February 2017.