title: Regional Versus General Anesthesia and the Incidence of Unplanned Health Care Resource Utilization for Postoperative Pain After Wrist Fracture Surgery: Results From a Retrospective Quality Improvement Project.
abstract: OBJECTIVE
  The establishment at our center of a dedicated regional anesthesia service in 2008-2009 has resulted in a marked increase in single-shot brachial plexus blocks (sBPBs) for ambulatory wrist fracture surgery. Despite the documented benefits of regional over general anesthesia (GA), there has been a perceived increase among sBPB patients in postoperative return rates for pain at our institution. We conducted a retrospective quality improvement project to examine this.
  
  
  METHODS
  After exemption from human ethics board review, we sought to identify and contact all wrist fracture surgery patients treated at our center between 2003 and 2012. Our primary outcome was the incidence of unplanned physician visits (office/clinic or emergency department) for pain in the first 48 hours after surgery. Other main outcomes included the incidence of seeking any form of medical attention for pain and self-reporting of severe pain in the first 48 hours.
  
  
  RESULTS
  Of 1008 identified patients, 419 could be contacted; 195 qualified for analysis. The incidence of unplanned physician visits in the first 48 hours was 12% (13 of 118) among sBPB patients versus 4% (3 of 77) in GA patients (odds ratio [OR], 3.1; 95% confidence interval [95% CI], 0.8-11.1; P = 0.11). More sBPB versus GA patients sought any form of medical attention for pain (20% vs 5%; OR, 4.7; 95% CI, 1.4-10.9; P = 0.003). Similarly, more sBPB patients reported severe postoperative pain (41% vs 10%; OR, 5.9; 95% CI, 2.6-13.4; P < 0.0001).
  
  
  CONCLUSIONS
  Patients who received sBPBs for ambulatory wrist fracture surgery had a higher rate of unplanned health care resource utilization caused by pain after hospital discharge than those undergoing GA. These findings warrant confirmation in a prospective trial and emphasize the need for a defined postdischarge analgesic pathway as well as the potential merits of perineural home catheters.
authors.affiliation: From the Department of Anesthesia, Division of Regional Anesthesia, St. Paul's Hospital; and Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Sunderland
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Yarnold
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Head
authors.forename: Jill A
authors.initials: JA
authors.lastname: Osborn
authors.forename: Andrew
authors.initials: A
authors.lastname: Purssell
authors.forename: John K
authors.initials: JK
authors.lastname: Peel
authors.forename: Stephan K W
authors.initials: SK
authors.lastname: Schwarz
mesh_terms: D000328:Adult; D000765:Anesthesia, Conduction / Q000639:trends*; D000768:Anesthesia, General / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data* / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D058996:Quality Improvement / Q000639:trends*; D012189:Retrospective Studies; D014954:Wrist Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*