Anesthesia method

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). The main purpose of this study was to investigate the impact; of the anesthesia method on patients’ postoperative opioid consumption during the first 3 days following surgery.

Anesthesia methods after surgical treatment of distal radial fracture; significantly impact early patterns of postoperative pain and opioid consumption equivalents, according to results. 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.

Assigned to general anesthesia

Researchers conducted a randomized clinical trial of 88 patients; who underwent volar plate fixation for displaced distal radial fractures. There were 44 patients assigned to general anesthesia and 44 patients had regional anesthesia. Total opioid equivalent consumption during the first 3 postoperative days was the primary outcome. 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.

The primary outcome was total opioid equivalent consumption (OEC); during the first 3 postoperative days (72 hours). Secondary outcomes included OEC during days 1, 2, and 3, visual analog scale (VAS) for pain scores; maximum pain, postoperative nausea and vomiting, perioperative time consumption (surgical, preoperative, and postoperative anesthesia care time); functional outcomes, and Patient-Rated Wrist Evaluation (PRWE) and EuroQol-5 Dimensions-3 Levels (EQ-5D-3L) scores up to 6 months.

Results showed that during the first 3 postoperative days; the total medial opioid equivalent consumption was 85 mg in patients given general anesthesia and was 60 mg in patients given regional anesthesia. Investigators noted 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.

Regard to fixation outcomes

Patients given general anesthesia compared with those 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. The anesthesia method (GA vs. RA) significantly influenced the early patterns of postoperative pain; and opioid consumption after surgical treatment of a distal radial fracture, but neither total OEC over the first 3 postoperative days; nor longer-term outcomes differed between the groups.