Comparison of Peripheral Nerve Blocks vs. Local Tissue Infiltration for Wrist Surgery: Effect on Postoperative Outcomes
Published on: 2016-12-12
Background: Local anesthetics are frequently administered during superficial ambulatory surgery procedures to reduce intra- and postoperative pain scores and opioid requirements. We designed a study to compare the analgesic efficacy of a peripheral nerve block (PNB) to local tissue infiltration for elective wrist surgery. We hypothesized that the use of a PNB would provide more effective pain relief after surgery. Methods: After obtaining Institutional Review Board (IRB) approval, the anesthesia and surgery records of 30 consenting outpatients undergoing wrist surgery with local anesthetic infiltration (n=15) or a PNB (n=15) were reviewed and the patients were asked to consent to completing a standardized follow-up questionnaire. Postoperative pain was assessed every 30min upon entering the postanesthesia care unit (PACU) and after discharge home using a numeric rating scale (NRS) score, with 0=no pain to 10=worst pain imaginable. In addition, the anesthesia and surgery times, the need for rescue (opioid) analgesic medication, postoperative side effects and complications, as well as overall satisfaction with their pain management and quality of recovery were recorded. Results: The two groups had similar demographic characteristics, including anesthesia and surgery times, as well as time to discharge home. The Operating Room (OR) time was similar in both groups. The PNB group had significant lower pain scores (p< 0.05) on entry into the PACU and lower maximum pain scores (p< 0.05) prior to discharge home and upon arrival at their home. However, patient satisfaction with their pain management and quality of recovery did not differ between the two groups. Conclusions: Compared to local anesthetic infiltration, regional anesthesia utilizing a PNB provided improved postoperative pain control in the early postoperative period without prolonging OR time or delaying discharge after outpatient wrist surgery.
Postoperative Pain; Peripheral Nerve Block (PNB); Local Tissue Infiltration; Wrist Surgery