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

Autor: Héroux J; Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada. jennifer.heroux@usherbrooke.ca.; Department of Anesthesiology, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada. jennifer.heroux@usherbrooke.ca., Bessette PO; Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada., Bédard S; Department of Orthopedic Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada.; Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada., Lamarche D; Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada., Gagnon A; Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada., Échavé P; Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada., Loignon MJ; Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada., Patenaude N; Department of Orthopedic Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada., Baillargeon JP; Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.; Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada., D'Aragon F; Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada.; Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
Jazyk: angličtina
Zdroj: Canadian journal of anaesthesia = Journal canadien d'anesthesie [Can J Anaesth] 2024 Jun; Vol. 71 (6), pp. 761-772. Date of Electronic Publication: 2023 Nov 06.
DOI: 10.1007/s12630-023-02615-y
Abstrakt: 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.
(© 2023. Canadian Anesthesiologists' Society.)
Databáze: MEDLINE
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