The effect of the type of anesthesia on the quality of postoperative recovery after orthopedic forearm surgery

Doo, A Ram; Kang, Sehrin; Kim, Ye Sull; Lee, Tae-Won; Lee, Jun-Rae; Kim, Dong-Chan

doi:10.4097/kja.19352

Cited by 9 publications

(18 citation statements)

References 24 publications

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“…27 Another study found no difference on the quality of postoperative recovery after orthopedic forearm surgery between brachial plexus block and general anesthesia, but in that study measurements were performed 24 h after surgery. 29 The lack of difference may be because as the effect of the nerve block wore off, the patient experienced severe rebound pain, which lowered the QoR score. 4 Our patients who received CISB consistently had NRS pain scores of 3 or lower, indicating satisfactory analgesia.…”

Section: Discussionmentioning

confidence: 99%

Comparison of continuous and single interscalene block for quality of recovery score following arthroscopic rotator cuff repair

Yun

Sim

et al. 2021

J Orthop Surg (Hong Kong)

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Background: Continuous interscalene brachial plexus block (CISB) is well known to reduce postoperative pain and to improve patient satisfaction. However, the effect of CISB on the quality of postoperative recovery is unknown. We Compared the quality of recovery from arthroscopic rotator cuff repair in patients who received CISB or single interscalene brachial plexus block (SISB). Methods: This prospective non-randomized controlled trial with propensity score matching enrolled 134 patients undergoing arthroscopic surgery for rotator cuff repair. Each patient received an interscalene block before surgery. One group had a catheter insertion 30 min after the end of surgery and started patient-controlled regional analgesia (PCRA, n = 49). The other group received intravenous patient-controlled analgesia (IV-PCA, n = 85). The primary outcome was the quality of recovery (QoR-40) score. Also, postoperative analgesia, sleep quality, and postoperative complications were evaluated. Results: The two groups had similar QoR-40 score on postoperative day-1 (POD1), but the PCRA group had a significantly greater QoR-40 score on POD2 (156.0, IQR: 143.0, 169.0 vs. 171.0, IQR: 159.0, 178.0; p < 0.001). The IV-PCA group received more analgesics during the 2 days after surgery, especially during night-time, and had a higher prevalence of sleep disturbances. The time to first additional analgesics request was significantly longer in PCRA group (14 hours, 95% CI: 13–16 vs. 44 hours, 95% CI: 28–not applicable). The incidence of postoperative nausea and vomiting significantly lower in the PCRA group (16.3% vs 46.9%, p = 0.002). Conclusion: CISB showed a higher quality of recovery score than SISB with IV-PCA in arthroscopic rotator cuff repair, probably related to the effective analgesia, improved sleep quality, and reduced opioid-related complications.

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Section: Discussionmentioning

confidence: 99%

Comparison of continuous and single interscalene block for quality of recovery score following arthroscopic rotator cuff repair

Yun

Sim

et al. 2021

J Orthop Surg (Hong Kong)

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“…Agreement between reviewers for relevance (k=0.85) and eligibility (k=1) was considered excellent. Ultimately we included three RCTs (36,39,40), two retrospective cohort studies (34,35) and one prospective cohort study (37). All studies were published in English between 2012 and 2020.…”

Section: Study Selectionmentioning

confidence: 99%

“…Study characteristics are summarized in Table 1 and for more details see Supplementary Table 4, Additional File 1. Five studies assessed clinical outcomes of the wrist using infraclavicular block (34,36,37,39,40), and one evaluated the shoulder joint using an interscalene block approach (35). The surgical indication was distal radial fracture xation (34,36,39,40), proximal humerus fracture xation (35) and multiples wrist surgery (e.g.…”

Section: Study Characteristicsmentioning

confidence: 99%

Functional Recovery with Peripheral Nerve Block Versus General Anesthesia for Upper Limb Surgery: A Systematic Review

Héroux

Bessette

Belley‐Côté

et al. 2022

Preprint

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Background Peripheral nerve block is a common anesthetic technique used during orthopedic upper limb surgery. Injection of local anesthetics around the target nerve inhibits the action of voltage-dependent sodium channels, inhibiting neurotransmission of pain impulses and providing motor immobility. Compared to general anesthesia, it could improve functional recovery by inhibiting nociceptive impulses and inflammation, thus reducing postoperative pain and immobilization and improving postoperative rehabilitation. This systematic review evaluates the impact of peripheral nerve block versus general anesthesia on postoperative functional recovery following orthopedic upper limb surgery. Methods We searched CENTRAL, MEDLINE, CINHAL, EMBASE, and Scopus trial databases from inception until September 2021 for studies comparing peripheral nerve block to general anesthesia. We collected data on functional recovery, range of motion, patient satisfaction, quality of life, and return to work. We pooled studies using a random-effects model and summarized the quality of evidence with the GRADE approach. Results We assessed 373 citations and 19 full-text articles for eligibility, and included six studies. Six studies reported on functional recovery, but failed to detect a significant superiority of peripheral nerve block over general anesthesia (3 RCT studies, N= 160; SMD -0.15; CI at 95% -0.60-0.3; I2=45%; p=0.07; low quality of evidence and 3 observational studies, N= 377; SMD -0.35; CI at 95% -0.71-0.01; I2=64%; p=0.06; very low quality of evidence). Conclusions Current literature is limited and fails to identify the benefit of peripheral nerve block on functional recovery. More studies are needed to assess the impact on long-term recovery. Considering the potential impact on clinical practice and training, a prospective study on functional recovery is ongoing (NCT04541745). Trial Registration: PROSPERO ID CRD42018116298. Registered on December 4, 2018.

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“…The QoR-40 has been used numerous times to measure patients’ recovery after different surgeries [ 8 , 9 ]. In addition, this questionnaire seems to be a reliable tool for assessing other techniques, including regional blocks [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

The quality of recovery after erector spinae plane block in patients undergoing breast surgery: a randomized controlled trial

et al. 2022

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Background The erector spinae plane (ESP) block has recently been shown to effectively alleviate postoperative pain and reduce opioid consumption in breast surgery patients. However, data are still limited concerning the quality of recovery in patients following this procedure. Methods This study was a randomized controlled trial (RCT) performed in a university hospital. We randomly allocated patients to one of three groups: ESP, SHAM, and control (CON). Procedures in the ESP and SHAM blocks were performed ipsilaterally with 0.375% ropivacaine or 0.9% saline (0.4 mL/kg). Our primary outcome was the assessment of the patient’s improvement with quality-of-recovery 40 (QoR-40) a day after surgery. Other outcome assessments included postoperative pain evaluation on the visual analog scale (VAS), 24-hour opioid consumption with patient-controlled analgesia (PCA), time to the first opioid demand, and global satisfaction with perioperative treatment. Results Overall, patients in the ESP group had improved QoR-40 compared to the CON group, 186 [177–193] vs. 175 [165–183] (medians and interquartile ranges). Pain severity was significantly higher in the CON group compared to the ESP group at hours 2 (38 [23–53] vs. 20 [7–32]) and 4 (30 [18–51] vs. 19 [7–25]). Moreover, we observed lower oxycodone consumption after 24 hours with the PCA pump between the ESP (4 [2–8] mg) and the CON (9.5 [5–19]) groups. Patients in the CON group used PCA sooner than those in the ESP group. Participants in the ESP group were more satisfied with treatment than those in the CON group. We found no statistical difference between SHAM and the other groups. Conclusions Compared to the CON group, the ESP block improved the quality of recovery, alleviated pain intensity, and lowered opioid consumption in patients undergoing breast surgery. However, we did not observe this superiority in comparison with the SHAM group. Trial registration NCT04726878.

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The effect of the type of anesthesia on the quality of postoperative recovery after orthopedic forearm surgery

Cited by 9 publications

References 24 publications

Comparison of continuous and single interscalene block for quality of recovery score following arthroscopic rotator cuff repair

Comparison of continuous and single interscalene block for quality of recovery score following arthroscopic rotator cuff repair

Functional Recovery with Peripheral Nerve Block Versus General Anesthesia for Upper Limb Surgery: A Systematic Review

The quality of recovery after erector spinae plane block in patients undergoing breast surgery: a randomized controlled trial

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