Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery.
BACKGROUND
The purpose of this study was to determine whether either regional anesthesia (RA) or general anesthesia (GA) provided the best analgesia with the fewest adverse effects up to 2 weeks after ambulatory hand surgery.


METHODS
Patients undergoing ambulatory hand surgery were randomly assigned to RA (axillary brachial plexus block; n = 50) or GA (n = 50). Before surgery, all patients rated their hand pain (visual analog scale) and pain-related disability (Pain-Disability Index). After surgery, eligibility for bypassing the postanesthesia care unit ("fast track") was determined, and pain, adverse effects, and home-readiness scores were measured. On postoperative days 1, 7, and 14, patients documented their pain, opioid consumption, adverse effects, Pain-Disability Index, and satisfaction.


RESULTS
More RA patients were fast-track eligible (P < 0.001), whereas duration of stay in the postanesthesia care unit was shorter in the RA group (P < 0.001). Time to first analgesic request was longer in the RA group (P < 0.001), and opioid consumption was reduced before discharge (P < 0.001). In the RA group, the pain ratings measured at 30, 60, 90, and 120 min after surgery were lower (P < 0.001), and patients spent less time in the hospital after surgery (P < 0.001). More GA patients experienced nausea/vomiting during recovery in the hospital (P < 0.05). However, on postoperative days 1, 7, and 14, there were no differences in pain, opioid consumption, adverse effects, Pain-Disability Index, or satisfaction.


CONCLUSIONS
Despite significant reduction in pain before discharge from the hospital after ambulatory hand surgery, single-shot axillary brachial plexus block does not reduce pain at home on postoperative day 1 or up to 14 days after surgery when compared with GA. However, RA does provide other significant early benefits, including reduction in nausea and faster discharge from the hospital.
Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. colin.mccartney@uhn.on.ca
Colin J L
CJ
McCartney
Richard
R
Brull
Vincent W S
VW
Chan
Joel
J
Katz
Sherif
S
Abbas
Brent
B
Graham
Hugo
H
Nova
Regan
R
Rawson
Dimitri J
DJ
Anastakis
Herbert
H
von Schroeder
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D000765:Anesthesia, Conduction / Q000009:adverse effects; D000768:Anesthesia, General / Q000009:adverse effects; D003061:Codeine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006225:Hand / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D017214:Laryngeal Masks; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000009:adverse effects / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D018401:Sample Size; D013997:Time Factors; D014111:Tourniquets
D000701:Analgesics, Opioid; D010098:Oxycodone; D003061:Codeine