Anaesthesia for open wrist fracture surgery in adults/elderly.

Irene Sellbrandt,Pether Jildenstål,Margareta Warrén Stomberg,Metha Brattwall,Jan G Jakobsson

doi:10.12688/f1000research.13004.1

Irene Sellbrandt, Pether Jildenstål + Show 3 more

Open Access

https://doi.org/10.12688/f1000research.13004.1

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Abstract

Anaesthetic technique for open surgery of acute distal for arm fracture in adults/elderly is not well defined. Regional anaesthesia, general anaesthesia or a combined general and regional block may be considered. General anaesthetic technique, the timing and drug/drug combination for the regional block must also be considered. This is a study around published studies assessing anaesthtic technique for wrist surgery. A systematic database search was performed and papers describing the effect of anaesthetic techniques were included. We found sparse evidence for what anaesthetic technique is optimal for open wrist fracture repair. In total only six studies were found using our inclusion criteria, which all supported the short term, early recovery benefits of regional anaesthesia as part of multi-modal analgesia. More protracted outcomes and putting the type of block into context of quality of recovery and patients' satisfaction is lacking in the literature. The risk for a pain rebound when the block vanishes should also be acknowledged. Therefore, further high quality studies are warranted concerning the anaesthetic technique for this type of surgery.

Highlights

Fracture on the upper limb is common, and fracture on the distal forearm, wrist fracture, is one of most common upper limb fractures
In 2009, Smektala et al.[7] conducted a cohort study around surgical wrist fracture care in Germany. They found that most patients were elderly females, and the predominant fracture management procedure was percutaneous K-wire osteosynthesis (56% of cases), followed by plate osteosynthesis (44%) and more than half of patients had general anaesthesia (55%)
Search strategy A systematic database search was performed on PubMed, Scopus and Cochrane databases, searching for articles in the period from 2007 to October 2017, to identify studies regarding the impact of anaesthesia method on pain and long term outcomes after open radius fracture repair

Summary

Introduction

Fracture on the upper limb is common, and fracture on the distal forearm, wrist fracture, is one of most common upper limb fractures. Whether the incident increases or declines at least among women is a matter of discussion[1,2]. The incidence is increasing among adults and elderly in Sweden[3]. There is seasonal variation of distal wrist fracture with high risk during winter months[4,5]. The best treatment of wrist fracture is debated. In 2009, Smektala et al.[7] conducted a cohort study around surgical wrist fracture care in Germany. They found that most patients were elderly females, and the predominant fracture management procedure was percutaneous K-wire osteosynthesis (56% of cases), followed by plate osteosynthesis (44%) and more than half of patients had general anaesthesia (55%)

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