Patient-Reported Quality of Recovery After Local Anaesthesia and Brachial Plexus Block in Hand Surgery: A Prospective Randomized Controlled Study

Canadian Society of Plastic Surgeons Société Canadienne des Chirurgiens Plasticiens The 2021 CSPS in-person Annual Meeting was cancelled due to the covid-19 pandemic. / La reunion annuelle présentielle 2021 de la SCCP a été annulée en raison de la pandémie de covid-19 The following abstracts were accepted for presentation online. / Les résumés suivants ont été sélectionnés pour présentation en ligne Bing Siang Gan, President / Président and Carolyn Levis, Vice-President & Scientific Program Chair / Vice-Présidente & Présidente du Comité de programme scientifique Abstracts (Podium Presentations):s (Podium Presentations): Psychometric Validation of the FACE-Q Craniofacial Module for Facial Nerve Paralysis A. Klassen, C. Rae, L. Gallo*, K. Wong, S. Cano, A. Pusic Hamilton, Ontario, Canada Abstract Purpose: Systematic reviews have identified the need for aPurpose: Systematic reviews have identified the need for a patient-reported outcome measure (PROM) specific to facial nerve paralysis (FNP). Our team developed a PROM for children and young adults with facial conditions, that is, FACE-Q Craniofacial module. The aim of this study was to describe the development and validation of this PROM in a combined sample of children and older adults with FNP. Methods: Data were collected between December 2016 and December 2019. For the qualitative study, samples of patients who varied by age, gender, and severity of FNP were interviewed. For the field test study, data were collected from patients aged 8 years and older with FNP. Participants completed relevant appearance, facial function, and health-related quality of life scales. Rasch measurement theory analysis was used to examine reliability and validity of the scales in the FNP sample. Results: The qualitative sample of 25 patients provided 2052 codes related to 4 top-level outcome domains: appearance, physical, psychological, and social function. Many of the concerns expressed by participants were common across age. The field test sample included 235 patients aged 8 to 81 years. Of the 13 FACE-Q Craniofacial module scales examined, all 122 items had ordered thresholds and good item fit to the Rasch model. For 12 scales, person separation index values were >0.79 and Cronbach a values were >.82. The 13th scale’s reliability values were >0.71. Conclusion: The scales described in this study can be used to collect and compare evidence-based outcomes data from children and adults with FNP. Teaching Objectives: Participants will understand the methods used to examine the psychometric properties of a newly developed patient-reported outcome measure. Learning Objectives: Participants will understand the methods used to examine the psychometric properties of a newly developed patient-reported outcome measure. Patient-Reported Quality of Recovery After Local Anaesthesia and Brachial Plexus Block in Hand Surgery: A Prospective Randomized Controlled Study F. Meng*, A. Baradaran, M. Mojtahed Jaberi, M. Luc, L. Xu, S. Thibaudeau Montréal, Quebec, Canada Plastic Surgery 2021, Vol. 29(3) 197-225 a 2021 The Author(s) Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/22925503211021684 journals.sagepub.com/home/psg Abstract Purpose: In hand surgery, both local and regional anaesthesia are commonly used analgesic modalities. Local anaesthesia (LA) is simple and efficient, though the brachial plexus block (BP) is often favoured for more complex hand surgeries despite requiring greater time and resources. The recovery of patients after undergoing hand surgery has never been directly compared between these 2 modalities. The primary objective is to compare the quality of recovery of patients who receive LA or BP. Secondary objectives are to compare post-operative pain and opioid use. Methods: This prospective randomized controlled study enrolled adult patients undergoing surgery distal to carpal bones. Participants were randomized to receive local anaesthesia as a wrist/digital block, or regional anaesthesia as an infraclavicular brachial plexus block. Participants completed the Quality of Recovery-15 questionnaire (QoR-15) on POD1, reported their pain level on the Numerical Pain Rating Scale (NPRS) and their narcotic use on POD1 and 3. Results: A total of 76 patients completed the QoR-15 (LA 46, BP 30). There was no statistically significant difference in QoR-15 score between LA (127.5 [IQR 28]) and BP (123.5 [IQR 31]). The non-inferiority of LA was demonstrated at the 95% CI. The post-operative pain and narcotic use for LA and BP on POD1 (NPRS 5 vs 4, P > .05; oxycodone pills 0.5 vs 1, P > .05) and POD3 (NPRS 1 vs 1, P > .05; oxycodone pills 2 vs 1, P > .05) were not significantly different. Conclusions: In hand surgery, LA is non-inferior to BP for quality of recovery, post-operative pain, and narcotic use. This study supports more widespread use of local anaesthesia in complex hand surgeries, which may greatly benefit OR efficiency, convenience, and costs. Learning Objectives: To understand the effect of anaesthesia type on patient-reported recovery, pain level, and narcotic use after hand surgery.Purpose: In hand surgery, both local and regional anaesthesia are commonly used analgesic modalities. Local anaesthesia (LA) is simple and efficient, though the brachial plexus block (BP) is often favoured for more complex hand surgeries despite requiring greater time and resources. The recovery of patients after undergoing hand surgery has never been directly compared between these 2 modalities. The primary objective is to compare the quality of recovery of patients who receive LA or BP. Secondary objectives are to compare post-operative pain and opioid use. Methods: This prospective randomized controlled study enrolled adult patients undergoing surgery distal to carpal bones. Participants were randomized to receive local anaesthesia as a wrist/digital block, or regional anaesthesia as an infraclavicular brachial plexus block. Participants completed the Quality of Recovery-15 questionnaire (QoR-15) on POD1, reported their pain level on the Numerical Pain Rating Scale (NPRS) and their narcotic use on POD1 and 3. Results: A total of 76 patients completed the QoR-15 (LA 46, BP 30). There was no statistically significant difference in QoR-15 score between LA (127.5 [IQR 28]) and BP (123.5 [IQR 31]). The non-inferiority of LA was demonstrated at the 95% CI. The post-operative pain and narcotic use for LA and BP on POD1 (NPRS 5 vs 4, P > .05; oxycodone pills 0.5 vs 1, P > .05) and POD3 (NPRS 1 vs 1, P > .05; oxycodone pills 2 vs 1, P > .05) were not significantly different. Conclusions: In hand surgery, LA is non-inferior to BP for quality of recovery, post-operative pain, and narcotic use. This study supports more widespread use of local anaesthesia in complex hand surgeries, which may greatly benefit OR efficiency, convenience, and costs. Learning Objectives: To understand the effect of anaesthesia type on patient-reported recovery, pain level, and narcotic use after hand surgery. Effect of Surgery Delay on Outcomes After Nerve Transfer to Restore Elbow Flexion K. Hicks*, J. Haas, M. Saggaf, A. Kiss, J. Dengler Toronto, Ontario, Canada Abstract Purpose: This study aims to investigate the impact of surgery delay on elbow flexion strength in patients with traumatic BPIs undergoing single fascicular nerve transfer (SFT) or double fascicular nerve transfer (DFT). Method: The protocol was registered with PROSPERO and PRISMA guidelines were followed. MEDLINE, EMBASE, and The Cochrane Library were systematically searched. English studies investigating the outcomes of SFT or DFT for restoration of elbow flexion in BPI were included. Two independent reviewers completed screening and data extraction. Data analyses were performed to determine the predictors of elbow flexion strength; surgery delay, age, injury level, and SFT versus DFT. Results: The literature search identified 1046 unique articles. Studies (n1⁄4 31) reporting individual patient data (n1⁄4 408 patients) who underwent SFT (n 1⁄4 341) or DFT (n 1⁄4 67) for restoration of elbow flexion were included for analysis. The mean age, time from injury to surgery, and follow-up were 29.6 years, 6.5 months, and 27.1 months, respectively. Good elbow flexion strength was found in most patients; MRC 3 in 352 (86.3%) and MRC 4 in 288 (70.6%). In the adjusted analysis, increased age (P 1⁄4 .0219), surgical delay (<0.0001), C5-7 (P 1⁄4 .0036), and pan-plexus injuries (P < .0001) were associated with worse motor recovery. A 32% reduction in the odds of a favourable motor recovery was observed with a 3-month delay to surgery. Patients who had their nerve transfer within 6 months of injury had 2.4 times the odds of favourable motor recovery (P 1⁄4 .0003, 95% CI: 1.50-3.92). Conclusions: Worse motor recovery was observed following nerve transfers in BPI with delay to surgery. SFT and DFT provide excellent elbow flexion strength in the majority of patients and should be considered as a reconstructive option to restore elbow flexion following BPI. Learning Objectives: Participants will understand the impact of surgery delay on elbow flexion strength in nerve transfers for BPI.Purpose: This study aims to investigate the impact of surgery delay on elbow flexion strength in patients with traumatic BPIs undergoing single fascicular nerve transfer (SFT) or double fascicular nerve transfer (DFT). Method: The protocol was registered with PROSPERO and PRISMA guidelines were followed. MEDLINE, EMBASE, and The Cochrane Library were systematically searched. English studies investigating the outcomes of SFT or DFT for restoration of elbow flexion in BPI were included. Two independent reviewers completed screening and data extraction. Data analyses were performed to determine the predictors of elbow flexion strength; surgery delay, age, injury level, and SFT versus DFT. Results: The literature search identified 1046 unique articles. Studies (n1⁄4 31) reportin