Functional recovery of wrist surgery with regional versus general anesthesia: a prospective observational study

• Published in: Canadian journal of anesthesia Vol. 71; no. 6; pp. 761 - 772
• Main Authors: Héroux, Jennifer, Bessette, Pierre-Olivier, Bédard, Sonia, Lamarche, Daphnée, Gagnon, Anthony, Échavé, Pablo, Loignon, Marie-Josée, Patenaude, Nicolas, Baillargeon, Jean-Patrice, D’Aragon, Frédérick
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2024; Springer Nature B.V
• Subjects: Adult; Aged; Anesthesia, Conduction - methods; Anesthesia, General - methods; Anesthesiology; Cardiology; Cohort Studies; Critical Care Medicine; Female; General anesthesia; Hand Strength; Humans; Intensive; Male; Medicine; Medicine & Public Health; Middle Aged; NCT; NCT04541745; Observational studies; Pain Medicine; Pain, Postoperative - drug therapy; Patient Satisfaction; Pediatrics; Pneumology/Respiratory System; Prospective Studies; Questionnaires; Radius Fractures - surgery; Range of motion; Range of Motion, Articular; Recovery of Function; Regional anesthesia; Regional Anesthesia and Acute Pain; Reports of Original Investigations; Surgery; Wrist - surgery; brachial plexus; peripheral anesthesia; postoperative recovery; functional recovery; nerve block; upper limb surgery
• ISSN: 0832-610X; 1496-8975; 1496-8975
• DOI: 10.1007/s12630-023-02615-y

Purpose Regional anesthesia may favour postoperative rehabilitation by inhibiting peripheral sensitization and secondary hyperalgesia. The literature on this subject is limited. In the present FUNCTION study, we sought to compare the functional recovery post orthopedic wrist surgery with regional versus general anesthesia. Methods We conducted a single-centre prospective observational cohort study in adult patients with a distal radial fracture. Functional recovery was assessed with validated psychometrics questionnaires (Quick Disabilities of Arm, Shoulder and Hand [QuickDASH] and Patient-Rated Wrist Evaluation [PRWE]), range of motion, and grip strength. We used a linear mixed regression model to assess the impact of the anesthesia technique on functional recovery. Postoperative pain and patient satisfaction were evaluated using a visual analog scale. Results We recruited 76 patients. At 12 weeks post surgery, there was no difference between the type of anesthesia and functional recovery with the QuickDASH (higher scores worse; regional anesthesia [RA], 22.7 vs general anesthesia [GA], 19.3; adjusted mean difference [aMD], −0.3; 95% confidence interval [CI], −9.6 to 9.0; P  = 0.9) and PRWE (higher scores worse; RA group, 21.0 vs GA group, 20.5; aMD, −3.3; 95% CI, −12.1 to 5.6; P  = 0.93) questionnaires. Range of motion, satisfaction, and postoperative pain were similar between groups. Right-hand grip strength was higher in the GA group. Conclusion Regional anesthesia was not associated with improved functional recovery compared with general anesthesia. The dominance of the operated limb was a confusion factor in all evaluation modalities. Further research taking into account the dominance of the hand is necessary to establish the effects of regional anesthesia on functional recovery. Study registration ClinicalTrials.gov (NCT04541745); registered 9 September 2020.