Functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery: a systematic review protocol

Functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery: a systematic review

BACKGROUND

Peripheral nerve block is a common anesthetic technique used during orthopedic upper limb surgery. Injection of local anesthetics around the target nerve inhibits the action of voltage-dependent sodium channels, inhibiting neurotransmission of pain impulses and providing motor immobility. Compared to general anesthesia, it could improve functional recovery by inhibiting nociceptive impulses and inflammation, thus reducing postoperative pain and immobilization and improving postoperative rehabilitation. This systematic review evaluates the impact of peripheral nerve block versus general anesthesia on postoperative functional recovery following orthopedic upper limb surgery.

METHODS

We searched CENTRAL, MEDLINE, CINHAL, EMBASE, and Scopus trial databases from inception until September 2021 for studies comparing peripheral nerve block to general anesthesia. We collected data on functional recovery, range of motion, patient satisfaction, quality of life, and return to work. We pooled studies using a random-effects model and summarized the quality of evidence with the GRADE approach.

RESULTS

We assessed 373 citations and 19 full-text articles for eligibility, and included six studies. Six studies reported on functional recovery, but failed to detect a significant superiority of peripheral nerve block over general anesthesia (3 RCT studies, N = 160; SMD -0.15; CI at 95% -0.60-0.3; I² = 45%; p = 0.07; low quality of evidence and 3 observational studies, N = 377; SMD -0.35; CI at 95% -0.71-0.01; I² = 64%; p = 0.06; very low quality of evidence).

CONCLUSIONS

Current literature is limited and fails to identify the benefit of peripheral nerve block on functional recovery. More studies are needed to assess the impact on long-term recovery. Considering the potential impact on clinical practice and training, a prospective study on functional recovery is ongoing (NCT04541745).

TRIAL REGISTRATION

PROSPERO ID CRD42018116298. Registered on December 4, 2018.

Minimally Invasive Plating of Distal Radius Fracture: A Series of 42 Cases and Review of Current Literature

Surgical techniques developed for distal radius fracture fixation have become increasingly advanced, including minimally invasive plate osteosynthesis (MIPO). This study aimed to introduce and evaluate the functional outcome of a novel MIPO technique that differs from previous reports. This study included 42 patients with distal radius fractures who underwent minimally invasive surgical plating of the distal radius. All patients were treated with closed reduction, fixation using K-wire, and subsequent insertion of a volar anatomical stable angle short plate on the distal radius. An arthroscopy-assisted evaluation and repair procedure were performed to correct intra-articular involvement, triangular fibrocartilage complex tears, and scapholunate injuries. Functional outcomes were assessed using a visual analog scale score; quick disabilities of the arm, shoulder, and hand score; and postoperative range of motion of flexion, extension, supination, and pronation at the 3-month follow-up, showing significant improvement in all parameters (all p ≤ 0.05). This study provides a simpler yet reliable method with reproducible and consistent results to treat distal radius fractures using minimally invasive plating with closed reduction and plate insertion, resulting in satisfactory clinical outcomes in all patients.

Giant tumor resection under ultrasound-guided nerve block in a patient with severe asthma: A case report

BACKGROUND

General anesthesia in critically ill patients is associated with increased risk of complications. Nerve block anesthesia is an alternative, but could be challenging in cases with surgical field that involves multiple dermatomes.

CASE SUMMARY

We report resection of a giant lipoma in the left shoulder and upper back under supraclavicular brachial plexus block plus T3-4 paravertebral block in an older patient with severe asthma. A 70-year-old patient presented with a slow-growing giant mass (25, 15 and 5 cm in length, width and depth, respectively) that extended from the lateral side of the left scapula to the axillary midline, and from the T5 thoracic vertebra intercostal to the mid-medial section of the left upper arm. He had sharp intermittent pain over the mass for the past 7 d. The patient also had severe bronchial asthma for the past 8 years. A pulmonary function test revealed only 20% of the predicted forced expiratory volume in 1 second (FEV1, 0.49 L). After controlling asthma with glucocorticoid, the tumor was resected under ultrasound-guided supraclavicular brachial plexus block and T3-4 paravertebral block. The surgery was completed without incident.

CONCLUSION

Ultrasound-guided regional nerve block is a viable alternative for patients with poor cardiopulmonary function undergoing shoulder, back and axillary surgery.