<b><span>Background:</span></b><span> Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). </span><span>Wheth...<b><span>Background:</span></b><span> Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). </span><span>Whether anesthesia type affects patient outcomes is unclear. </span><span>This study retrospectively compared patient satisfaction between GA and NB after surgery. </span><b><span>Methods: </span></b><span>This was a historical cohort study of 80 (34 GA and 46 NB) patients who underwent volar plate fixation of distal radius fractures. Propensity score analysis was used to generate a set of matched cases (NB) and controls (GA), yielding 14 matched patient-pairs. The simplified patient satisfaction scale was compared for primary outcomes. Secondary outcomes were anesthesia and surgery duration, hospital stay length, adverse events, postoperative analgesic requirement, and wrist range of motion (ROM) 2 weeks and 3 months postoperatively.</span><span> </span><b><span>Results:</span></b><span> After propensity score matching, patients in almost all cases in both groups were “Satisfied” (effect size: 0.1, p</span><span> </span><span>=</span><span> </span><span>0.572), indicating little significant difference. Significant differences in adverse events and postoperative analgesic use observed before matching disappeared after matching. Anesthesia duration and hospital stay length were significantly shorter in the NB group (effect size: </span><span>-</span><span>1.27 and </span><span>-</span><span>0.77, p</span><span> </span><span>=</span><span> </span><span>0.00074 and p</span><span> </span><span>=</span><span> </span><span>0.0388, respectively), as was surgery duration (effect size: </span><span>-</span><span>0.84, p</span><span> </span><span>=</span><span> </span><span>0.0122) after matching. Similar to before matching, wrist ROM significantly improved in the NB group (effect size: 1.11, p</span><span> </span><span>=</span><span> </span><span>0.0279) in the early postoperative period, but the difference disappeared at 3 months postoperatively.</span><span> </span><b><span>Conclusions:</span></b><span> Patient satisfaction between distal radius fracture surgery under GA and NB was similar. Nerve block could help shorten hospital stay length and surgery duration and improve postoperative functional recovery.</span>展开更多
Bilateral brachial plexus blocks and regional anesthesia in trauma patients are rarely performed due to potential complications when using these techniques. We illustrate a case in which bilateral infraclavicular nerv...Bilateral brachial plexus blocks and regional anesthesia in trauma patients are rarely performed due to potential complications when using these techniques. We illustrate a case in which bilateral infraclavicular nerve blocks were placed as part of a multimodal approach to pain management in a trauma patient. We discuss potential hazards, important considerations, and rationale for attempting this procedure. Ultimately, performing bilateral brachial plexus nerve blocks in trauma patients is a viable option when choosing pain management techniques.展开更多
Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Pati...Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Patient evaluation for regional anesthesia should include neurological,pulmonary,cardiovascular,and hematological assessments.Neuraxial blocks include spinal,epidural,and combined spinal epidural.Upper extremity peripheral nerve blocks include interscalene,supraclavicular,infraclavicular,and axillary.Lower extremity peripheral nerve blocks include femoral nerve block,saphenous nerve block,sciatic nerve block,iPACK block,ankle block and lumbar plexus block.The choice of regional anesthesia is a unanimous decision made by the surgeon,the anesthesiologist,and the patient based on a risk-benefit assessment.The choice of the regional block depends on patient cooperation,patient positing,operative structures,operative manipulation,tourniquet use and the impact of postoperative motor blockade on initiation of physical therapy.Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity(LAST),nerve injury,falls,hematoma,infection and allergic reactions.Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications.LAST treatment guidelines and rescue medications(intralipid)should be readily available during the regional anesthesia administration.展开更多
文摘<b><span>Background:</span></b><span> Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). </span><span>Whether anesthesia type affects patient outcomes is unclear. </span><span>This study retrospectively compared patient satisfaction between GA and NB after surgery. </span><b><span>Methods: </span></b><span>This was a historical cohort study of 80 (34 GA and 46 NB) patients who underwent volar plate fixation of distal radius fractures. Propensity score analysis was used to generate a set of matched cases (NB) and controls (GA), yielding 14 matched patient-pairs. The simplified patient satisfaction scale was compared for primary outcomes. Secondary outcomes were anesthesia and surgery duration, hospital stay length, adverse events, postoperative analgesic requirement, and wrist range of motion (ROM) 2 weeks and 3 months postoperatively.</span><span> </span><b><span>Results:</span></b><span> After propensity score matching, patients in almost all cases in both groups were “Satisfied” (effect size: 0.1, p</span><span> </span><span>=</span><span> </span><span>0.572), indicating little significant difference. Significant differences in adverse events and postoperative analgesic use observed before matching disappeared after matching. Anesthesia duration and hospital stay length were significantly shorter in the NB group (effect size: </span><span>-</span><span>1.27 and </span><span>-</span><span>0.77, p</span><span> </span><span>=</span><span> </span><span>0.00074 and p</span><span> </span><span>=</span><span> </span><span>0.0388, respectively), as was surgery duration (effect size: </span><span>-</span><span>0.84, p</span><span> </span><span>=</span><span> </span><span>0.0122) after matching. Similar to before matching, wrist ROM significantly improved in the NB group (effect size: 1.11, p</span><span> </span><span>=</span><span> </span><span>0.0279) in the early postoperative period, but the difference disappeared at 3 months postoperatively.</span><span> </span><b><span>Conclusions:</span></b><span> Patient satisfaction between distal radius fracture surgery under GA and NB was similar. Nerve block could help shorten hospital stay length and surgery duration and improve postoperative functional recovery.</span>
文摘Bilateral brachial plexus blocks and regional anesthesia in trauma patients are rarely performed due to potential complications when using these techniques. We illustrate a case in which bilateral infraclavicular nerve blocks were placed as part of a multimodal approach to pain management in a trauma patient. We discuss potential hazards, important considerations, and rationale for attempting this procedure. Ultimately, performing bilateral brachial plexus nerve blocks in trauma patients is a viable option when choosing pain management techniques.
文摘Regional anesthesia is an integral component of successful orthopedic surgery.Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Patient evaluation for regional anesthesia should include neurological,pulmonary,cardiovascular,and hematological assessments.Neuraxial blocks include spinal,epidural,and combined spinal epidural.Upper extremity peripheral nerve blocks include interscalene,supraclavicular,infraclavicular,and axillary.Lower extremity peripheral nerve blocks include femoral nerve block,saphenous nerve block,sciatic nerve block,iPACK block,ankle block and lumbar plexus block.The choice of regional anesthesia is a unanimous decision made by the surgeon,the anesthesiologist,and the patient based on a risk-benefit assessment.The choice of the regional block depends on patient cooperation,patient positing,operative structures,operative manipulation,tourniquet use and the impact of postoperative motor blockade on initiation of physical therapy.Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity(LAST),nerve injury,falls,hematoma,infection and allergic reactions.Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications.LAST treatment guidelines and rescue medications(intralipid)should be readily available during the regional anesthesia administration.
