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Functional recovery of wrist surgery with regional versus general anesthesia: a prospective observational study

Récupération fonctionnelle après une chirurgie du poignet réalisée sous anesthésie régionale ou générale : une étude observationnelle prospective

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Abstract

Purpose

Regional anesthesia may favour postoperative rehabilitation by inhibiting peripheral sensitization and secondary hyperalgesia. The literature on this subject is limited. In the present FUNCTION study, we sought to compare the functional recovery post orthopedic wrist surgery with regional versus general anesthesia.

Methods

We conducted a single-centre prospective observational cohort study in adult patients with a distal radial fracture. Functional recovery was assessed with validated psychometrics questionnaires (Quick Disabilities of Arm, Shoulder and Hand [QuickDASH] and Patient-Rated Wrist Evaluation [PRWE]), range of motion, and grip strength. We used a linear mixed regression model to assess the impact of the anesthesia technique on functional recovery. Postoperative pain and patient satisfaction were evaluated using a visual analog scale.

Results

We recruited 76 patients. At 12 weeks post surgery, there was no difference between the type of anesthesia and functional recovery with the QuickDASH (higher scores worse; regional anesthesia [RA], 22.7 vs general anesthesia [GA], 19.3; adjusted mean difference [aMD], −0.3; 95% confidence interval [CI], −9.6 to 9.0; P = 0.9) and PRWE (higher scores worse; RA group, 21.0 vs GA group, 20.5; aMD, −3.3; 95% CI, −12.1 to 5.6; P = 0.93) questionnaires. Range of motion, satisfaction, and postoperative pain were similar between groups. Right-hand grip strength was higher in the GA group.

Conclusion

Regional anesthesia was not associated with improved functional recovery compared with general anesthesia. The dominance of the operated limb was a confusion factor in all evaluation modalities. Further research taking into account the dominance of the hand is necessary to establish the effects of regional anesthesia on functional recovery.

Study registration

ClinicalTrials.gov (NCT04541745); registered 9 September 2020.

Résumé

Objectif

L’anesthésie régionale pourrait favoriser la rééducation postopératoire en inhibant la sensibilisation périphérique et l’hyperalgésie secondaire. La littérature à ce sujet est limitée. Dans la présente étude nommée FUNCTION, nous avons cherché à comparer la récupération fonctionnelle après une chirurgie orthopédique du poignet réalisée sous anesthésie régionale vs sous anesthésie générale.

Méthode

Nous avons réalisé une étude de cohorte observationnelle prospective monocentrique auprès de patient·es adultes présentant une fracture radiale distale. La récupération fonctionnelle a été évaluée à l’aide de questionnaires psychométriques validés (questionnaires QuickDASH [Quick Disabilities of Arm, Shoulder and Hand] et PRWE [Patient-Rated Wrist Evaluation]), de l’amplitude des mouvements et de la force de préhension. Nous avons utilisé un modèle de régression linéaire mixte pour évaluer l’impact de la technique d’anesthésie sur la récupération fonctionnelle. La douleur postopératoire et la satisfaction des patient·es ont été évaluées à l’aide d’une échelle visuelle analogique.

Résultats

Nous avons recruté 76 personnes. Douze semaines après la chirurgie, il n’y avait aucune différence entre le type d’anesthésie et la récupération fonctionnelle selon le questionnaire QuickDASH (scores plus élevés les pires; anesthésie régionale [AR], 22,7 vs anesthésie générale [AG], 19,3; différence moyenne ajustée [DMa], −0,3; intervalle de confiance [IC] à 95 %, −9,6 à 9,0; P = 0,9) et PRWE (scores plus élevés les pires; groupe AR, 21,0 vs groupe AG, 20,5; DMa, −3,3; IC 95 %, −12,1 à 5,6; P = 0,93). L’amplitude des mouvements, la satisfaction et la douleur postopératoire étaient similaires entre les groupes. La force de préhension de la main droite était plus élevée dans le groupe AG.

Conclusion

L’anesthésie régionale n’a pas été associée à une amélioration de la récupération fonctionnelle par rapport à l’anesthésie générale. La prédominance du membre opéré était un facteur de confusion dans toutes les modalités d’évaluation. D’autres recherches tenant compte du côté dominant au niveau des mains sont nécessaires pour déterminer les effets de l’anesthésie régionale sur la récupération fonctionnelle.

Enregistrement de l’étude

ClinicalTrials.gov (NCT04541745); enregistrée le 9 septembre 2020.

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Author contributions

All authors contributed to the conception of the study, acquisition of data, analysis and interpretation of the data, and drafting and revision of the manuscript.

Acknowledgement

The authors wish to acknowledge M. Samuel Lemaire-Paquette for performing the statistical analysis and for insights into interpreting the results.

Disclosures

All authors report no competing interests.

Funding statement

The project was funded by internal departmental funds provided by the anesthesiology department at the CIUSSS de l’Estrie CHUS and la Fondation de recherche et de l’enseignement en orthopédie de Sherbrooke (FREOS). Drs D’Aragon and Baillargeon are supported by Fonds de Recherche du Québec – Santé.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Deputy Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada

    Jennifer Héroux MD, Pierre-Olivier Bessette MD, Daphnée Lamarche PhD, Anthony Gagnon, Pablo Échavé MD, Marie-Josée Loignon MD & Frédérick D’Aragon MD, MSc

  2. Department of Orthopedic Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada

    Sonia Bédard Phys. T & Nicolas Patenaude MD

  3. Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada

    Sonia Bédard Phys. T, Jean-Patrice Baillargeon MD, MSc & Frédérick D’Aragon MD, MSc

  4. Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada

    Jean-Patrice Baillargeon MD, MSc

  5. Department of Anesthesiology, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada

    Jennifer Héroux MD

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  1. Jennifer Héroux MD
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Héroux, J., Bessette, PO., Bédard, S. et al. Functional recovery of wrist surgery with regional versus general anesthesia: a prospective observational study. Can J Anesth/J Can Anesth (2023). https://doi.org/10.1007/s12630-023-02615-y

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