File Download

There are no files associated with this item.

Conference Paper: Effects of Infraclavicular nerve block versus General Anaesthesia for Acute postoperative pain after distal radial fracture surgery

TitleEffects of Infraclavicular nerve block versus General Anaesthesia for Acute postoperative pain after distal radial fracture surgery
Authors
Issue Date13-Sep-2018
PublisherInternational Association for the Study of Pain (IASP) .
Citation
17th World Congress on Pain, Boston, USA, 12-16 September 2018 How to Cite?
AbstractAim of Investigations: Both general anaesthesia and regional anaesthesia with brachial plexus blocks are common anaesthetic techniques for distal radial fracture surgery. Peripheral nerve block provides preventive analgesia and has been shown to reduce postoperative pain, opioid consumption, and improve patient satisfaction after surgery [1-4]. A retrospective study showed that infraclavicular nerve block was associated with reduced pain and higher functional scores compared with general anaesthesia at 3 and 6 months after distal radial fracture surgery [5]. On the other hand, a randomized controlled trial involving 36 patients did not show analgesic benefit with infraclavicular nerve block during the acute postoperative period [6]. In this study, we compared acute postoperative analgesia between general anaesthesia and regional anaesthesia using infraclavicular nerve block in patients undergoing distal radial fracture surgery. Methods: A single blind randomized controlled trial was performed in 50 patients scheduled for distal radial fracture surgery. Patients were randomly assigned to receive either general anaesthesia (GA, n=25) or infraclavicular nerve block under ultrasound guidance (RA, n=25). Patients in RA group were given 15-20ml of local anaesthetic solution (solution made up from 10ml 2% lignocaine with 1:200,000 adrenaline plus 10 ml of 0.75% ropivicaine), followed by propofol sedation. Patients in GA group were given propofol and fentanyl for induction, followed by maintenance with sevoflurane. They were also given morphine intraoperatively and local wound infiltration with levobupivicaine. An independent investigator blinded to patient allocation assessed pain scores, patient satisfaction, and recorded data on analgesic drug use. Results: Median numerical pain scores (NRS) at rest and with movement on arrival and discharge from the postoperative anaesthetic care unit (PACU), at 2 hours, 1 day, and 2 days after surgery was significantly lower in the RA group compared to GA group (p<0.001-0.004). Mean NRS pain score measured by area under curve (AUC) at rest and with movement on postoperative days 1 and 2 was also significantly lower in the RA group (p<0.001). Morphine consumption in the PACU and paracetamol consumption 2 hours after surgery was significantly lower in RA group (p<0.001 for morphine consumption, p=0.043 for paracetamol consumption). Postoperative dihydrocodeine consumption and paracetamol consumption at other time points was not significantly different between the two groups. Patients in RA group were significantly less likely to have dizziness on postoperative day 1 (p=0.049). There were no differences in incidence of other adverse effects and patient satisfaction with analgesic management. Conclusions: Patients receiving regional anaesthesia with infraclavicular nerve block for distal radial fracture surgery had better postoperative pain control and reduced opioid consumption in the PACU than those receiving general anaesthesia. References : 1. Kessler, J., et al., Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years. Br J Anaesth, 2015. 114(5): p. 728-45. 2. Barreveld, A., et al., Preventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs. Anesth Analg, 2013. 116(5): p. 1141-61. 3. Hadzic, A., et al., A comparison of infraclavicular nerve block versus general anesthesia for hand and wrist day-case surgeries. The Journal of the American Society of Anesthesiologists, 2004. 101(1): p. 127-132. 4. O'Donnell, B.D., et al., Ultrasound-guided axillary brachial plexus block with 20 milliliters local anesthetic mixture versus general anesthesia for upper limb trauma surgery: an observer-blinded, prospective, randomized, controlled trial. Anesth Analg, 2009. 109(1): p. 279-83. 5. Egol, K.A., et al., Regional anesthesia improves outcome after distal radius fracture fixation over general anesthesia. J Orthop Trauma, 2012. 26(9): p. 545-9. 6. Galos, D.K., et al., Does Brachial Plexus Blockade Result in Improved Pain Scores After Distal Radius Fracture Fixation? A Randomized Trial. Clin Orthop Relat Res, 2016. 474(5): p. 1247-54.
DescriptionSession: Specific Pain Conditions / Pain in Specific Populations: Acute Pain - Poster presentation no. PTH324
Persistent Identifierhttp://hdl.handle.net/10722/263596

 

DC FieldValueLanguage
dc.contributor.authorWong, SCS-
dc.contributor.authorChan, TCW-
dc.contributor.authorChung, YF-
dc.contributor.authorFang, CX-
dc.contributor.authorCheung, CW-
dc.date.accessioned2018-10-22T07:41:28Z-
dc.date.available2018-10-22T07:41:28Z-
dc.date.issued2018-09-13-
dc.identifier.citation17th World Congress on Pain, Boston, USA, 12-16 September 2018-
dc.identifier.urihttp://hdl.handle.net/10722/263596-
dc.descriptionSession: Specific Pain Conditions / Pain in Specific Populations: Acute Pain - Poster presentation no. PTH324-
dc.description.abstractAim of Investigations: Both general anaesthesia and regional anaesthesia with brachial plexus blocks are common anaesthetic techniques for distal radial fracture surgery. Peripheral nerve block provides preventive analgesia and has been shown to reduce postoperative pain, opioid consumption, and improve patient satisfaction after surgery [1-4]. A retrospective study showed that infraclavicular nerve block was associated with reduced pain and higher functional scores compared with general anaesthesia at 3 and 6 months after distal radial fracture surgery [5]. On the other hand, a randomized controlled trial involving 36 patients did not show analgesic benefit with infraclavicular nerve block during the acute postoperative period [6]. In this study, we compared acute postoperative analgesia between general anaesthesia and regional anaesthesia using infraclavicular nerve block in patients undergoing distal radial fracture surgery. Methods: A single blind randomized controlled trial was performed in 50 patients scheduled for distal radial fracture surgery. Patients were randomly assigned to receive either general anaesthesia (GA, n=25) or infraclavicular nerve block under ultrasound guidance (RA, n=25). Patients in RA group were given 15-20ml of local anaesthetic solution (solution made up from 10ml 2% lignocaine with 1:200,000 adrenaline plus 10 ml of 0.75% ropivicaine), followed by propofol sedation. Patients in GA group were given propofol and fentanyl for induction, followed by maintenance with sevoflurane. They were also given morphine intraoperatively and local wound infiltration with levobupivicaine. An independent investigator blinded to patient allocation assessed pain scores, patient satisfaction, and recorded data on analgesic drug use. Results: Median numerical pain scores (NRS) at rest and with movement on arrival and discharge from the postoperative anaesthetic care unit (PACU), at 2 hours, 1 day, and 2 days after surgery was significantly lower in the RA group compared to GA group (p<0.001-0.004). Mean NRS pain score measured by area under curve (AUC) at rest and with movement on postoperative days 1 and 2 was also significantly lower in the RA group (p<0.001). Morphine consumption in the PACU and paracetamol consumption 2 hours after surgery was significantly lower in RA group (p<0.001 for morphine consumption, p=0.043 for paracetamol consumption). Postoperative dihydrocodeine consumption and paracetamol consumption at other time points was not significantly different between the two groups. Patients in RA group were significantly less likely to have dizziness on postoperative day 1 (p=0.049). There were no differences in incidence of other adverse effects and patient satisfaction with analgesic management. Conclusions: Patients receiving regional anaesthesia with infraclavicular nerve block for distal radial fracture surgery had better postoperative pain control and reduced opioid consumption in the PACU than those receiving general anaesthesia. References : 1. Kessler, J., et al., Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years. Br J Anaesth, 2015. 114(5): p. 728-45. 2. Barreveld, A., et al., Preventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs. Anesth Analg, 2013. 116(5): p. 1141-61. 3. Hadzic, A., et al., A comparison of infraclavicular nerve block versus general anesthesia for hand and wrist day-case surgeries. The Journal of the American Society of Anesthesiologists, 2004. 101(1): p. 127-132. 4. O'Donnell, B.D., et al., Ultrasound-guided axillary brachial plexus block with 20 milliliters local anesthetic mixture versus general anesthesia for upper limb trauma surgery: an observer-blinded, prospective, randomized, controlled trial. Anesth Analg, 2009. 109(1): p. 279-83. 5. Egol, K.A., et al., Regional anesthesia improves outcome after distal radius fracture fixation over general anesthesia. J Orthop Trauma, 2012. 26(9): p. 545-9. 6. Galos, D.K., et al., Does Brachial Plexus Blockade Result in Improved Pain Scores After Distal Radius Fracture Fixation? A Randomized Trial. Clin Orthop Relat Res, 2016. 474(5): p. 1247-54.-
dc.languageeng-
dc.publisherInternational Association for the Study of Pain (IASP) .-
dc.relation.ispartof17th World Congress on Pain (2018)-
dc.titleEffects of Infraclavicular nerve block versus General Anaesthesia for Acute postoperative pain after distal radial fracture surgery-
dc.typeConference_Paper-
dc.identifier.emailWong, SCS: wongstan@hku.hk-
dc.identifier.emailChan, TCW: timkat@hkucc.hku.hk-
dc.identifier.emailChung, YF: chungyf@hku.hk-
dc.identifier.emailFang, CX: cfang@hku.hk-
dc.identifier.emailCheung, CW: cheucw@hku.hk-
dc.identifier.authorityWong, SCS=rp01789-
dc.identifier.authorityFang, CX=rp02016-
dc.identifier.authorityCheung, CW=rp00244-
dc.identifier.hkuros294431-
dc.publisher.placeUnited States-

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats