Anesthesia method impacts post surgery for distal radial fracture patients

Stockholm, Sweden: Anesthesia methods (general anesthesia or regional anesthesia) in patients undergoing surgery for the treatment of a distal radial fracture, significantly impacts opioid consumption and early patterns of postoperative pain. But neither total opioid equivalent consumption (OEC) over the first 3 postoperative days nor longer-term outcomes differed between the groups.

These are the findings of a recent study published in the Journal of Bone and Joint Surgery.

Most patients undergoing surgery for the treatment of a distal radial fracture are treated in a day-surgery setting and are given either general anesthesia (GA) or regional anesthesia (RA). Johanna Rundgren, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden, and colleagues investigated the impact of the anesthesia method on patients' postoperative opioid consumption during the first 3 days following surgery.

This single-centre randomized clinical trial involved 88 patients who had undergone volar plate fixation for displaced distal radial fractures. 44 patients assigned to general anaesthesia and 44 patients had regional anaesthesia.

The primary outcome was total opioid equivalent consumption during the first 3 postoperative days. Other outcomes included the VAS for pain, maximum pain, postoperative nausea and vomiting, perioperative time consumption, function outcomes, patient-rated wrist evaluation and EuroQoL-5D three levels (EQ-5D-3L) up to 6 months.

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Key findings include:

• During the first 3 postoperative days, the total medial opioid equivalent consumption was 85 mg in patients given general anaesthesia and was 60 mg in patients given regional anesthesia.


• The groups were significantly different with regard to opioid equivalent consumption and VAS pain score during the first 24 hours postoperatively.


• Patients given general anesthesia had higher median opioid equivalent consumption prior to discharge, whereas this measure was higher after discharge in patients given regional anesthesia.


• Patients given general anesthesia compared with those who were given regional anesthesia had more pain immediately after surgery and at 2 hours postoperatively.


• In patients given general anesthesia, maximum pain occurred at a median of 1 hour after the end of surgery. This occurred at a median of 11 hours in patients given regional anesthesia.


• The total median perioperative time consumption in patients given general anesthesia was 244 minutes vs. 146 minutes for those given regional anesthesia.


• Groups were not significantly different with regard to fixation outcomes, patient-rated wrist evaluation and EQ-5D-3L at 6 months.

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"Anesthesia methods after surgical treatment of distal radial fracture significantly impact early patterns of postoperative pain and opioid consumption equivalents. However, no difference was seen between anesthesia methods with regard to total opioid equivalent consumption during the first 3 postoperative days and long-term outcomes," concluded the authors.

To read the complete study log on to doi: 10.2106/JBJS.18.00984