Local anaesthesia vs. brachial plexus block in trapeziometacarpal joint arthroplasty.

Autor: Moshammer M; Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, Graz, 8036, Austria.; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29 34 /4, Graz, 8036, Austria.; COREMED - Centre for Regenerative Medicine and Precisions Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstrasse 2, Graz, 8010, Austria., Klim SM; Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, Graz, 8036, Austria., Glehr R; Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Auenbruggerplatz 20, Graz, 8036, Austria., Hauer G; Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, Graz, 8036, Austria., Hecker A; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29 34 /4, Graz, 8036, Austria.; COREMED - Centre for Regenerative Medicine and Precisions Medicine, Joanneum Research Forschungsgesellschaft mbH, Neue Stiftingtalstrasse 2, Graz, 8010, Austria., Leithner A; Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, Graz, 8036, Austria., Glehr M; Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, Graz, 8036, Austria. mathias.glehr@medunigraz.at.
Jazyk: angličtina
Zdroj: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2024 Dec 21; Vol. 145 (1), pp. 83. Date of Electronic Publication: 2024 Dec 21.
DOI: 10.1007/s00402-024-05637-3
Abstrakt: Introduction: An established anaesthetic procedure used during total trapeziometacarpal joint (TMCJ) arthroplasty is the brachial plexus block (BPB). It was hypothesized that local anaesthesia (LA) provides advantages in overall cost, enables intraoperative assessment of the prosthesis, and minimises the anaesthetic risk. In this study, LA to BPB was compared and outcomes, safety, and overall patient satisfaction were analyzed.
Materials and Methods: In this single-center cohort study, 32 patients (34 operated thumbs) who underwent total TMCJ arthroplasty between February 2018 and July 2021 were included. Two groups were formed depending on the anaesthetic method used. One group was operated under LA, and the other under BPB. Functionality scores were assessed preoperatively and three month postoperatively. Additionally, pain was assessed on the 1st and 12th postoperative day. Data on intraoperative pain and anxiety, overall satisfaction, pain medication use, and willingness to undergo the procedure again were gathered through a retrospective telephone survey.
Results: No significant differences between LA and BPB were found in terms of functional outcomes, pain reduction, and willingness to repeat the procedure. The analysis further showed significant differences in intraoperative anxiety (higher in the LA group; LA 1.69, SD: 2.65; BPB 0.28, SD: 0.58; measured using a numeric rating scale 0-10; p = 0.045), operation length (higher in BPB group; LA 39 min, SD: 7.46; BPB 45 min, SD: 7.02; p = 0.018) and overall setup time (higher in BPB group; LA 76 min, SD: 15.85; BPB 102 min, SD: 19.66; p < 0.001). No conversion from LA to another anaesthetic method was necessary.
Conclusion: The use of LA in total TMCJ arthroplasty is a practical and reliable alternative to the well-established BPB. LA reduces the cost of the procedure, necessity of an anaesthesiology team and the duration of the patients´ hospital stay. Patients should be actively involved in selecting the anaesthetic method to optimize the operative procedure and overall outcome.
Competing Interests: Declarations. Conflict of interest: Andreas Leithner declares potential indirect conflict of interest through institutional educational grants by Alphamed, Johnson & Johnson, ImplanTec and Medacta. All other authors declare that they have no conflict of interest.
(© 2024. The Author(s).)
Databáze: MEDLINE
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