General versus Brachial Plexus Block Anesthesia in Pain Management after Internal Fixation in Patients with Distal Radius Fracture: A Randomized Controlled Trial

Distal radius fractures (DRFs) are very common injuries associated with aging, and the number of fractures is increasing with the increase in the elderly population. General anesthesia or brachial plexus block (BPB) is required for fracture fixation, and acute postoperative pain control is necessary after operation. Early pain control can improve patient satisfaction and functional outcomes. In this study, we report the clinical differences in postoperative pain, according to the method of anesthesia (general anesthesia versus brachial plexus block). Volar plating was used to treat 72 patients older than 60 years who had comminuted DRF. Patients were randomized to either group A (36 patients), who underwent general anesthesia, or group B (36 patients), who underwent BPB. We compared these two groups prospectively for acute postoperative pain using a visual analog scale (VAS) at 2, 4, 6, 12, and 24 h after surgery. The VAS scores of each group were: 6.8 +/- 2.5 in general anesthesia and 0.5 +/- 2.3 in BPB at 2 h, postoperatively; 6.5 +/- 2.4 in general anesthesia and 0.5 +/- 2.4 in BPB anesthesia at 4 h, postoperatively; 5.2 +/- 2.4 in general anesthesia and 1.5 +/- 2.4 in BPB anesthesia at 6 h, postoperatively; 4.5 +/- 2.5 in general anesthesia and 3.4 +/- 2.7 in BPB anesthesia at 12 h, postoperatively; and 3.5 +/- 2.5 in general anesthesia and 3.2 +/- 2.7 in BPB anesthesia at 24 h, postoperatively. DRF patients with BPB anesthesia showed a lower VAS score than those subjected to general anesthesia in early postoperative period. As a result, the effect of BPB anesthesia on acute pain management after surgery was excellent, which resulted in a lower pain score compared with general anesthesia in DRF patients undergoing volar plating.