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Randomized Controlled Trial
. 2020 May 28;20(1):130.
doi: 10.1186/s12871-020-01044-4.

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

Stanley S Wong  1 , Wing S Chan  2 , Christian Fang  3 , Chi W Chan  4 , Tak W Lau  5 , Frankie Leung  3 , Chi W Cheung  2
Affiliations
Randomized Controlled Trial

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

Stanley S Wong et al. BMC Anesthesiol. .

Abstract

Background: 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.

Methods: 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.

Result: 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.

Conclusion: 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.

Trial registration: Before subject enrollment, the study was registered at ClinicalTrials.gov (NCT03048214) on 9th February 2017.

Keywords: Distal radial fracture fixation; General anesthesia; Infraclavicular nerve block; Postoperative pain; Regional anesthesia.

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Conflict of interest statement

The authors have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of patients enrolled in the study
Fig. 2
Fig. 2
Postoperative numerical rating scale (NRS) pain scores of patients given regional anesthesia with infraclavicular nerve block (RA) or general anesthesia (GA) at rest (a) and during movement of the operated upper limb (b) at each recording time point. RR indicates on arrival to the post-anesthetic care unit; PO1hr = 1 h after surgery, PO2hr = 2 h after surgery; PO24hr = 24 h after surgery; PO48hr = 48 h after surgery; 3 and 6 months = 3 and 6 months after surgery. Solid circle represents GA; solid triangle represents RA. Values expressed in median [Interquartile range] * Significantly different at P ≤ 0.05. All differences in postoperative median NRS pain scores up to 48 h (at rest and with movement) remained statistically significant with adjusted P ≤ 0.05 even after post hoc adjustment with Bonferroni multiple comparisons
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