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

• DOI: 10.1007/s11999-016-4735-1
• Publication Date: 2016-02-11T21:03:04Z
• Authors: David K. Galos; David P. Taormina; Alexander Crespo; David Y. Ding; Anthony Sapienza; Sudheer Jain; Nirmal C. Tejwani
• Keywords: Distal radius fracture; Brachial plexus block

Distal radius fractures are very common injuries and surgical treatment for them can be painful. Achieving early pain control may help improve patient satisfaction functional outcomes. Little is known about which anesthesia technique (general versus brachial plexus blockade) most beneficial after distal fixation could significantly affect patients' postoperative course experience.We asked: (1) Did patients receiving general or blockade have worse scores at 2, 12, 24 hours surgery? (2) Was there a difference in operative suite time between who had blockade, was recovery room time? (3) higher narcotic use (4) Do assessment fracture repair 6 weeks 12 surgery?A randomized controlled study performed February, 2013 April, 2014 multicenter metropolitan tertiary-care referral center. Patients presented with acute closed (Orthopaedic Trauma Association 23A-C) were potentially eligible inclusion. During the period, 40 closed, displaced, unstable identified as meeting inclusion criteria offered enrollment randomization. Three (7.5%), all concomitant injuries, declined to participate of randomization did one additional (2.5%) chose not participate, leaving final sample 36 participants. There no dropouts randomization, analyses according an intention-to-treat model. randomly assigned two groups, among included, 18 each group. Medications administered postanesthesia care unit recorded. discharged oxycodone acetaminophen 5/325 mg control, VAS forms provided. called predetermined intervals postoperatively (2 hours, 4 48 72 hours) gather scores, using VAS, document doses analgesics consumed. In addition, regular followups 2 weeks, weeks. Pain again recorded these visits.Patients received 6.7 ± 2.3 vs 1.4 2.3; mean difference, 5.381; 95% CI, 3.850-6.913; p < 0.001); whereas reported 3.8 1.9 6.3 2.4; -2.535; -4.028 -1.040; = 0.002) 2.2 5.3 2.5; -1.492; -3.105 0.120; 0.031).There 119 16 minutes 125 23 minutes; 0.432), but greater (284 137 197 90; 0.0398). consumed more fentanyl (64 μg 93 6.9 14 μg; 0.001) morphine (2.9 3.6 0.0 than blockade. Functional outcome differ (data, SD both value) value).Brachial during immediate perioperative period different from that undergoing fractures. However, experienced increase surgery. Acknowledging "rebound pain" regional coupled counseling regarding administration allow effective control. It important conversation preoperatively what expect rebound pain, advise being aggressive taking medication before waning keep step ahead their management.Level 1, therapeutic study.