Evaluation of early postoperative pain and the effectiveness of perifracture site injections following volar plating for distal radius fractures.

Abstract

PURPOSE:

Few studies have investigated the effectiveness of early postoperative pain control regimens after volar plating for distal radius fractures. This study evaluated postoperative levels of pain after volar plating of distal radius fractures under axillary nerve block in patients with and without injections of local anesthetics, narcotics, and epinephrine around the fracture site.

METHODS:

Perioperative pain levels were prospectively assessed in 44 consecutive patients who had had volar plating for a distal radius fracture under axillary nerve block at a mean time of 2.8 days after trauma. Intravenous, patient-controlled analgesia and prescheduled analgesic medications were administered to all patients. In addition, patients were randomly allocated to 2 groups: perifracture site injection (PI; n = 22) and no perifracture site injection (no-PI; n = 22). At the end of surgery, PI group patients were administered perifracture site injections and blocks of the superficial radial and interosseous nerves with a local anesthetic mixture consisting of ropivacaine, morphine, and epinephrine. During the first 48 hours after surgery, pain visual analog scale (VAS) scores (0 to 100), total amount of narcotic consumption, incidences of additional narcotic requirement, and opioid-related side effects were assessed.

RESULTS:

The overall mean pain VAS scores among all 44 study subjects were 29 before surgery, and 58, 47, 40, and 27 at 4, 8, 24, and 48 hours after surgery, respectively. Thirteen patients needed additional pain rescue despite the multimodal analgesic approach used. No intergroup differences were observed between the PI and no-PI groups in terms of VAS pain scores, total narcotic consumption, adjuvant pain rescue incidence, and opioid-related side effects.

CONCLUSIONS:

Postoperative mean pain VAS scores after volar plating of distal radius fractures were found to be 58 at 4 hours and 47 at 8 hours. Perifracture site injections were not found to provide any additional pain control benefit.

TYPE OF STUDY/LEVEL OF EVIDENCE:

Therapeutic II.

• Authors: Moon Sang Chung, Young Hak Roh, Goo Hyun Baek, Young Ho Lee, Seung Hwan Rhee, Hyun Sik Gong
• Journal: The Journal of hand surgery (J Hand Surg Am) Vol. 35 Issue 11 Pg. 1787-94 (Nov 2010) ISSN: 1531-6564 [Electronic] United States
• PMID: 20961701 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Chemical References

• Amides
• Anesthetics, Local
• Ropivacaine

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Amides (administration & dosage)
• Analgesia, Patient-Controlled (methods)
• Anesthetics, Local (administration & dosage)
• Bone Plates
• Combined Modality Therapy
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Female
• Follow-Up Studies
• Fracture Fixation, Internal (instrumentation, methods)
• Humans
• Injections, Intra-Articular
• Intra-Articular Fractures (diagnostic imaging, surgery)
• Male
• Middle Aged
• Nerve Block (methods)
• Pain Measurement (drug effects)
• Pain, Postoperative (drug therapy, physiopathology, prevention & control)
• Prospective Studies
• Radiography
• Radius Fractures (diagnostic imaging, surgery)
• Range of Motion, Articular (drug effects, physiology)
• Ropivacaine
• Wrist Injuries (diagnostic imaging, surgery)
• Young Adult