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Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery.

Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery.

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Title: Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery.
Author: McCartney, Colin JL
Brull, Richard
Chan, Vincent W. S.
Katz, Joel
Abbas, Sherif
Graham, Brent
Nova, Hugo
Rawson, Regan
Anastakis, Dimitri
von Schroeder, Herbert
Abstract: 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, singleshot 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.
Type: Article
Rights: http://journals.lww.com/anesthesiology/pages/articleviewer.aspx?year=2004&issue=08000&article=00028&type=abstract
http://journals.lww.com/co-anesthesiology/pages/default.aspx
http://www.lww.com
URI: http://hdl.handle.net/10315/26532
Published: Lippincott, Williams & Wilkins
Citation: Anesthesiology. 2004 Aug;101(2):461-7.
ISSN: ISSN: 0003-3022, ESSN: 1528-1175
Date: 2004-08

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