Does intravenous patient-controlled analgesia or continuous block prevent rebound pain following infraclavicular brachial plexus block after distal radius fracture fixation? A prospective randomized controlled trial.

IF 4.2 4区 医学 Q1 ANESTHESIOLOGY
Korean Journal of Anesthesiology Pub Date : 2023-12-01 Epub Date: 2023-04-24 DOI:10.4097/kja.23076
Jong-Hyuk Lee, Ha-Jung Kim, Jae Kwang Kim, Sungjoo Cheon, Young Ho Shin
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引用次数: 0

Abstract

Background: The purpose of this study was to investigate the role of opioid-based intravenous patient-controlled analgesia (IV PCA) or continuous brachial plexus block (BPB) in controlling rebound pain after distal radius fracture (DRF) fixation under BPB as well as total opioid consumption.

Methods: A total of 66 patients undergoing surgical treatment for a displaced DRF with volar plate fixation were randomized to receive a single infraclavicular BPB (BPB only group) (n = 22), a single infraclavicular BPB with IV PCA (IV PCA group) (n = 22), or a single infraclavicular BPB with continuous infraclavicular BPB (continuous block group) (n = 22). The visual analog scale (VAS) for pain and the amount of pain medication were recorded at 4, 6, 9, 12, 24, and 48 h and two weeks postoperatively.

Results: At postoperative 9 h, the pain VAS score was significantly higher in the BPB only group (median: 2; Q1, Q3 [1, 3]) than in the IV PCA (0 [0, 1.8], P = 0.006) and continuous block groups (0 [0, 0.5], P = 0.009). At postoperative 12 h, the pain VAS score was significantly higher in the BPB only group (3 [3, 4]) than in the continuous block group (0.5 [0, 3], P = 0.004). The total opioid equivalent consumption (OEC) was significantly higher in the IV PCA group (350.3 [282.1, 461.3]) than in the BPB only group (37.5 [22.5, 75], P < 0.001) and continuous block group (30 [15, 75], P < 0.001); however, OEC was not significantly different between the BPB only group and the continuous block group (P = 0.595).

Conclusions: Although continuous infraclavicular BPB did not reduce total opioid consumption compared to BPB only, this method is effective for controlling rebound pain at postoperative 9 and 12 h following DRF fixation under BPB.

静脉自控镇痛或持续阻滞是否能预防桡骨远端骨折固定后锁骨下臂丛阻滞后的反弹疼痛?一项前瞻性随机对照试验。
背景:本研究的目的是探讨基于阿片类药物的静脉自控镇痛(IV PCA)或连续臂丛阻滞(BPB)在控制桡骨远端骨折(DRF)内固定后反弹疼痛以及阿片类药物总消耗的作用。方法:66例接受手术治疗的移位性DRF伴侧板固定的患者随机分为单锁骨下BPB组(单纯BPB组)(n = 22)、单锁骨下BPB联合IV PCA组(n = 22)和单锁骨下BPB联合连续锁骨下BPB组(连续阻断组)(n = 22)。分别于术后4、6、9、12、24、48 h和2周记录疼痛视觉模拟评分(VAS)和止痛药用量。结果:术后9 h, BPB组疼痛VAS评分明显高于单纯BPB组(中位数:2;Q1, Q3[1,3])高于IV PCA组(0 [0,1.8],P = 0.006)和连续阻滞组(0 [0,0.5],P = 0.009)。术后12 h,单纯BPB组疼痛VAS评分(3[3,4])明显高于连续阻滞组(0.5 [0,3],P = 0.004)。IV PCA组的总阿片类药物等效消耗量(OEC)为350.3[282.1,461.3],明显高于单纯BPB组(37.5 [22.5,75],P < 0.001)和连续阻滞组(30 [15,75],P < 0.001);而单纯BPB组与连续阻滞组OEC差异无统计学意义(P = 0.595)。结论:尽管与单纯的锁骨下BPB相比,持续的锁骨下BPB并没有减少阿片类药物的总消耗,但该方法可以有效地控制DRF固定后9和12小时的反跳疼痛。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.20
自引率
6.90%
发文量
84
审稿时长
16 weeks
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