Local/Regional Anesthesia Versus General Anesthesia in Phalanx Fractures/Dislocations

Abstract

Background: Traditionally, surgical repair of phalanx fractures was performed under general anesthesia. However, the emergence of regional and local anesthesia, otherwise known as Wide-awake Local Anesthesia No Tourniquet, provides an alternative approach where general anesthesia is undesirable. The choice of anesthetic approach resides with clinicians, though it is important to factor in the evidence that regional/local provides not only an alternative anesthesia approach but also potentially avoids comorbidities associated with general anesthesia. This study hypothesizes that the use of local/regional anesthesia for phalanx fracture/dislocation has comparable outcomes to general anesthesia and provides for fewer adverse events. Methods: To answer the research purpose, the investigators designed and implemented a retrospective cohort study of consecutive cases reported to the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database between January 1, 2015, and December 31, 2019. The study population included patients in the NSQIP database who underwent operative fixation of a phalanx fracture or dislocation in 2 cohorts, those with local/regional anesthesia or general anesthesia. The predictor variables were preoperative patient demographic data, including age, gender, surgical specialty, elective surgery, diabetes, smoking, hypertension, and open wound. Results: A total of 2831 patients were identified in the NSQIP database between January 1, 2015, and December 31, 2019. Local/regional anesthesia was performed in 13% of patients with the remaining 87% receiving general anesthesia. Surgical site occurrences were not clinically significant between the 2 groups. Overall, 30-day post-operative complications in the local/regional cohort included one patient with a deep vein thrombosis (0.03%) and pulmonary embolus (0.02%). Overall, 30-day post-operative complications in the general anesthesia cohort included pneumonia (0.12%) and stroke (0.08%). Conclusions: Surgery using the regional/local anesthesia techniques for patients with phalanx fractures or dislocations is safe and can be used in situations where general anesthesia is undesirable as post-operative 30-day complications are similar to those with general anesthesia.