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.
In the ambulatory surgery setting, postoperative pain results in discomfort, insomnia, fatigue, delayed discharge home, and is the most frequent cause of unanticipated hospital admissions. Pain management techniques are highly variable depending on the practice setting, patient co-morbidities, and the goals of the surgical care team. Traditionally, opioid analgesics have been the primary drugs used for pain management during and after ambulatory surgery. However, opioid analgesics are associated with cardiorespiratory depression, postoperative nausea and vomiting (PONV), post-discharge nausea and vomiting (PDNV), constipation, ileus, bladder dysfunction, pruritus and sedation. Local anesthetics are being increasingly utilized as part of a multimodal perioperative analgesic regimen in an effort to improve patient safety and reduce postoperative pain and opioid-related side effects. However, the optimal route of local anesthetic administration (i.e., local tissue infiltration, wound instillation, peripheral nerve block [PNB]) for superficial outpatient procedures is not known. The purpose of this study was to compare the postoperative recovery profiles (e.g., pain scores, PONV, PDNV, patient satisfaction with pain management and quality of recovery) of outpatients who underwent open reduction and internal fixation (ORIF) of the wrist with either local tissue infiltration or a PNB. We hypothesized that the use of the PNB would provide superior postoperative pain control compared to tissue infiltration and lead to improved recovery outcomes.