Patient-Reported Quality of Recovery of Local Anesthesia and Brachial Plexus Block in Hand Surgery: a Prospective Randomized Controlled Study
Fanyi Meng, MD1; Aslan Baradaran, MD, MSc1; Mehrad Mojtahed Jaberi, MD1; De QH Tran, MD, FRCPC2; Roderick Finlayson, MD, FRCPC1; Mario Luc, MD, FRCSC3; Liqin Xu, MDCM, MSc, FRCSC2; Stephanie Thibaudeau, MD, FRCSC1
1McGill University Health Centre, Montreal, QC, Canada; 2McGill University, Montreal, QC, Canada; 3Division of Plastic and Reconstructive Surgery, McGill University, Montreal, QC, Canada
In hand surgery, both local anesthesia (LA) and regional anesthesia are commonly used analgesic modalities. LA has increased efficiency and reduced costs; however, in most centers, regional anesthesia with brachial plexus block (BP) is favored for more complex hand surgeries despite requiring greater time and resources. The quality of recovery of patients undergoing hand surgery has not been directly compared between these two modalities. The primary objective of this study is to assess the quality of recovery of patients who receive either LA or BP, as measured by the Quality of Recovery-15 score (QoR-15), a psychometrically validated patient reported outcome scale. Secondary objectives are to compare post-operative pain and opioid use.
This REB-approved prospective, randomized, controlled, non-inferiority study enrolled patients undergoing surgery distal to the carpal bones. Consenting patients were randomized to receive either local anesthesia as a wrist or digital block (LA), or an infraclavicular brachial plexus block (BP) prior to surgery. Patients completed the QoR-15 questionnaire on post-operative day one (POD1). The QoR-15 is scored on a maximum of 150 points, with a higher score signifying a better recovery. Patients also rated their level of pain from 0 to 10 on the Numerical Pain Rating Scale (NPRS) and reported their narcotic consumption on POD1 and 3. Values are reported as median [IQR] and non-parametric statistics were performed, with alpha=0.05.
A total of 105 patients were enrolled, of which 76 completed the QoR-15 (LA 46, BP 30). There was no statistically significant difference on the QoR-15 score on POD1 between LA (127.5 [IQR 28]) and BP (123.5 [IQR 31]). The upper bound of the 95% CI interval for the difference of the medians (+5) did not exceed our non-inferiority margin which was set at 8. In addition, the pain levels on the NPRS on POD1 (LA=5, BP=4.5, p>0.05) and POD3 (LA=1, BP=1, p>0.05) were not statistically different between groups. The number of oxycodone pills consumed on POD1 (LA=2, BP=1, p>0.05) and POD3 (LA=2, BP=2, p>0.05) was also not significantly different between groups.
LA is non-inferior to the BP block for hand surgery in regard to patient-reported quality of recovery, post-operative pain, and narcotics use. This study supports more widespread use of local anesthesia for hand surgeries performed in the operating room, which may greatly benefit OR efficiency, convenience, and financial costs.
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