Wang Jia,Han Chao,Wang Yufeng,et al.Effects of different anesthetic methods on early outcomes of distal radius fractures in children: a single-center,prospective,randomized controlled study[J].Journal of Clinical Pediatric Surgery,,21():265-271.[doi:10.3760/cma.j.cn101785-202107013-012]
Effects of different anesthetic methods on early outcomes of distal radius fractures in children: a single-center,prospective,randomized controlled study
- Abstract:
- Objective To explore the effects of different anesthetic methods on early outcomes of distal radius fracture in children.Methods For this single-center, prospective, randomized controlled study, 90 children aged 6-12 years undergoing open reduction and internal fixation of distal radius fractures were randomly divided into two groups of nerve block anesthesia (RA, n=45) and general anesthesia (GA, n=45).GA group received routine general anesthesia while RA group ultrasound-guided subclavian brachial plexus block.The major outcomes were range-of-motion score, grip strength test score, 40-item recovery quality score and patient-rated wrist evaluation at Month 1 post-operation.The secondary outcomes were pain scores at preoperative, immediately post-operation, 2/8/24/48/72 h, 2 weeks and 1 month post-operation.Tme and intensity of postoperative peak pain; consumption of paracetamol and codeine tablets at Day 1 (P1), Day 2 (P2) and Day 3 (P3) post-operation, cumulative consumption of paracetamol and codeine tablets 1-3 (T1-3) post-operation and time of initial dosing of paracetamol and codeine tablets; incidence of nausea and vomiting within 24 h post-operation, incidence of unplanned postoperative hospital admission and anesthetic satisfaction.Results Finally 44 cases in GA group and 43 cases in RA group completed the data collection at all timepoints.No inter-group statistical significance existed in general profiles (P>0.05).Pain scores of RA group were lower than those of GA group at immediately post-operation and 2/8h post-operation.And the difference was statistically significant (P<0.05).Pain score at 24 h post-operation in RA group was higher than that in GA group and the difference was statistically significant (P<0.05).Peak time of postoperative pain was later in RA group than that in GA group.And the difference was statistically significant (P<0.05).The consumption of paracetamol and codeine tablets at Day 1 post-operation in RA group was significantly lower than that in GA group (P<0.05).And cumulative consumption of paracetamol and codeine tablets at Day 1 to Day 3 post-operation was significantly lower in RA group than that in GA group (P<0.05).Time of initial oral administration of paracetamol and codeine tablets was significantly later in RA group than that in GA group (P<0.05).No significant inter-group difference existed in joint range-of-motion score or grip strength test score.Patient-rated wrist evaluation score was lower in RA group than that in GA group at Month 1 post-operation (P<0.05).Total scores of QOR-40, emotional state, physical comfort and psychological support items at Month 1 post-operation were all higher in RA group than those in GA group (P<0.05).Conclusion Brachial plexus block anesthesia is more effective than general anesthesia in relieving early postoperative pain, reducing dependence on analgesics and lowering the incidence of nausea and vomiting.More importantly, brachial plexus block anesthesia offers better recovery quality and patient-rated wrist evaluation scores than general anesthesia at Month 1 post-operation.And the application of nerve block technology is promising in pediatric orthopedics.
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Memo
收稿日期:2021-07-06。
基金项目:辽宁省教育厅科研基金项目（2019-117-14）
通讯作者:蔡振存,Email:caizhencun@126.com