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Sellbrant I, Nellgård B, Karlsson J, Albert J, Jakobsson JG. Anaesthesia practice, quality indices including all-cause 30-day mortality associate to wrist fracture repositioning and surgery in Sweden: A perioperative register-based study 2018-2021. Acta Anaesthesiol Scand 2024; 68:402-409. [PMID: 37952557 DOI: 10.1111/aas.14358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/03/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Wrist fracture is one of most common fractures frequently requiring surgical anaesthesia. There is limited information related to the anaesthetic practice and quality including 30-day mortality associated with wrist fracture in Sweden in recent years. AIM The aim of the present register-based study was to investigate the anaesthesia techniques used and quality indices including 30-day mortality associated with wrist fracture surgery in Sweden during the period 2018-2021. MATERIALS AND METHODS All fracture repositions, and surgical interventions related to wrist fracture requiring anaesthesia in patients aged >18 years registered in the Swedish Perioperative Register (SPOR) between 2018 and 2021 were included in the analysis. Information on age, ASA class, anaesthesia technique, severe operative events, most reported side-effects during recovery room stay and all-cause 30-day mortality was collected. RESULTS The data set included 25,147 procedures split into 14,796 females and 10,252 males (missing information n = 99) with a mean age of 52.9 ± 18.7 years and a significant age difference between females and males, 60.3 ± 15.4 and 42.2 ± 17.7 years, respectively. Mean age and ASA class increased during the study period (2018-2021), from 52.8 ± 18.6 to 54.0 ± 18.4 and ASA class 3-5 from 8.1% to 9.4% (p < .001 and p < .041, respectively). General anaesthesia (GA), GA combined with regional anaesthesia (RA), RA with or without sedation and sedation only was used in 41%, 13%, 40% and 6% of procedures, respectively, with minor changes over the study period. Pain at arrival in the recovery room (RR), (3.4%), severe pain during RR stay (2.1%), hypothermia (1.4%), postoperative nausea and vomiting (PONV) (1.2%) and urinary retention (0.5%) were the most reported side-effects during the RR stay. (RA) was associated with significantly lower occurrence of pain and PONV, and shorter RR stay, compared with GA (p < .001). The all-cause 30-day mortality was low (19 of 25,147 (0.08%)) with no differences over the period studied or anaesthetic technique. CONCLUSION General anaesthesia or general anaesthesia combined with regional anaesthesia are the most used anaesthetic techniques for wrist fracture procedures in Sweden. Recovery room pain, PONV, hypothermia and urinary retention is reported in overall low frequencies, with no change over the period studied, but in lower frequencies for regional anaesthesia. All-cause 30-day mortality was low; 0.08% with no change over time or between anaesthetic techniques. Thus, the present quality review based on SPOR data supports high quality of perioperative anaesthesia care.
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Affiliation(s)
- Iren Sellbrant
- Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Bengt Nellgård
- Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Johanna Albert
- Department of Anaesthesia and Intensive Care, Department for Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Jan G Jakobsson
- Department of Anaesthesia and Intensive Care, Department for Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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Roh YH, Park SG, Lee SH. Regional versus General Anesthesia in Postoperative Pain Management after Distal Radius Fracture Surgery: Meta-Analysis of Randomized Controlled Trials. J Pers Med 2023; 13:1543. [PMID: 38003859 PMCID: PMC10671853 DOI: 10.3390/jpm13111543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Distal radius fractures are the most prevalent upper extremity fractures, posing a significant public health concern. Recent studies comparing regional and general anesthesia for postoperative pain management after these fractures have yielded conflicting results. This meta-analysis aimed to compare the effectiveness of regional and general anesthesia concerning postoperative pain management and opioid consumption following distal radius fracture surgery. A comprehensive search was conducted in PubMed, Cochrane Library, and EMBASE databases to identify relevant randomized controlled trials. Four randomized trials involving 248 participants were included in the analysis. A pooled analysis revealed that regional anesthesia led to significantly reduced postoperative pain scores at 2 h compared to general anesthesia (SMD -2.03; 95% CI -2.88--1.17). However, no significant differences in pain scores were observed between the two anesthesia types after 12 h post-surgery. Regional anesthesia was associated with lower total opioid consumption (SMD -0.76; 95% CI -1.25--0.26) and fewer occurrences of nausea and vomiting compared to the general anesthesia. Nonetheless, opioid consumption on the first day post-discharge was significantly higher in the regional anesthesia group (SMD 0.83; 95% CI 0.47-1.20). The analgesic superiority of regional anesthesia is confined to the early postoperative hours with overall lower opioid use but a notable increase in opioid consumption on the first day post-discharge, potentially attributable to rebound pain.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea; (S.G.P.); (S.H.L.)
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Sciard D, Xu K, Soulier A, Dufour G, Ursino M, Alberti C, Beaussier M. Postoperative analgesia after surgical repair of distal radius fracture: a randomized comparison between distal peripheral nerve blockade and surgical site infiltration. Minerva Anestesiol 2023; 89:876-883. [PMID: 36800809 DOI: 10.23736/s0375-9393.23.16956-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Pain following open reduction and internal fixation of distal radius fracture (DRF) can be significant. This study compared the intensity of pain up to 48 hours after volar plating for DRF, associated to either an ultrasound guided distal nerve block (DNB) or surgical site infiltration (SSI). METHODS In this prospective single blind randomized study, 72 patients scheduled for DRF surgery under 1.5% lidocaine axillary block were allocated to receive, at the end of surgery, either an ultrasound-guided median and radial nerves block with ropivacaine 0.375% (DNB) performed by the anesthesiologist or a SSI with the same drug regimen, performed by the surgeon. Primary outcome was the duration between analgesic technique (H0) and pain reappearance (Numerical Rating Scale (NRS 0-10)>3). Secondary outcomes were the quality of analgesia, the quality of sleep, the magnitude of motor blockade, and the patient satisfaction. The study was built on a statistical hypothesis of equivalence. RESULTS Fifty-nine patients were included in the final per-protocol analysis (DNB=30, SSI=29). Time to reach NRS>3 was (in median [95%CI]) 267 min [155;727] and 164 min [120;181] respectively after DNB and SSI (difference=103 min [-22;594] - rejection of equivalence hypothesis). Pain intensity throughout the 48 hours, quality of sleep, opiate consumption, motor blockade and patient satisfaction was not significantly different between groups. CONCLUSIONS Although DNB provides a longer analgesia than SSI, both techniques gave comparable level of pain control during the first 48 hours after surgery, without any difference in the incidence of side effects or patient satisfaction.
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Affiliation(s)
- Didier Sciard
- Department of Anesthesiology, Montsouris Mutualist Institute, Paris, France
| | - Kailai Xu
- Department of Anesthesiology and Intensive Care, St Antoine Hospital, Hospitals of Paris, Paris, France
| | - Anne Soulier
- Department of Anesthesiology and Intensive Care, St Antoine Hospital, Hospitals of Paris, Paris, France
| | - Guillaume Dufour
- Department of Anesthesiology, Montsouris Mutualist Institute, Paris, France
| | - Moreno Ursino
- Unit of Clinical Epidemiology, Public Assistance, Hospitals of Paris, CHU Hôpital Robert Debré, Paris, France
- Inserm, Center of research of Cordeliers, Sorbonne University, University of Paris, Paris, France
| | - Corinne Alberti
- Unit of Clinical Epidemiology, Public Assistance, Hospitals of Paris, CHU Hôpital Robert Debré, Paris, France
| | - Marc Beaussier
- Department of Anesthesiology, Montsouris Mutualist Institute, Paris, France -
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Sellbrant I, Karlsson J, Jakobsson JG, Nellgård B. Supraclavicular block with Mepivacaine vs Ropivacaine, their impact on postoperative pain: a prospective randomised study. BMC Anesthesiol 2021; 21:273. [PMID: 34753423 PMCID: PMC8577027 DOI: 10.1186/s12871-021-01499-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Supraclavicular block (SCB) with long-acting local anaesthetic is commonly used for surgical repair of distal radial fractures (DRF). Studies have shown a risk for rebound pain when the block fades. This randomised single-centre study aimed to compare pain and opioid consumption the first three days post-surgery between SCB-mepivacaine vs. SCB-ropivacaine, with general anaesthesia (GA) as control. METHODS Patients (n = 90) with ASA physical status 1-3 were prospectively randomised to receive; SCB with mepivacine 1%, 25-30 ml (n = 30), SCB with ropivacaine 0.5%, 25-30 ml (n = 30) or GA (n = 30) with propofol/fentanyl/sevoflurane. Study objectives compared postoperative pain with Numeric Rating Scale (NRS) and sum postoperative Opioid Equivalent Consumption (OEC) during the first 3 days post-surgery between study-groups. RESULTS The three groups showed significant differences in postoperative pain-profile. Mean NRS at 24 h was significantly lower for the SCB-mepivacaine group (p = 0.018). Further both median NRS and median OEC day 0 to 3 were significanly lower in the SCB-mepivacaine group as compared to the SCB-ropivacaine group during the first three days after surgery; pain NRS 1 (IQR 0.3-3.3) and 2.7 (IQR 1.3-4.2) (p = 0.017) and OEC 30 mg (IQR 10-80) and 85 mg (IQR 45-125) (p = 0.004), respectively. The GA-group was in between both in pain NRS and median sum OEC. Unplanned healthcare contacts were highest among SCB-ropivacaine patients (39.3%) vs. SCB-mepivacaine patients (0%) and GA-patients (3.4%). CONCLUSIONS The potential benefit of longer duration of analgesia, associated to a long-acting local anaesthetic agent, during the early postoperative course must be put in perspective of potential worse pain progression following block resolution. TRIAL REGISTRATION NCT03749174 (clinicaltrials.gov, Nov 21, 2018, retrospectively registered).
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Affiliation(s)
- Irén Sellbrant
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Jon Karlsson
- Department of Orthopedic Surgery, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan G Jakobsson
- Department of Anaesthesia & Intensive Care, Institute of Clinical Science, Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Ananda A, Ngan KH, Karabağ C, Ter-Sarkisov A, Alonso E, Reyes-Aldasoro CC. Classification and Visualisation of Normal and Abnormal Radiographs; A Comparison between Eleven Convolutional Neural Network Architectures. SENSORS (BASEL, SWITZERLAND) 2021; 21:5381. [PMID: 34450821 PMCID: PMC8400172 DOI: 10.3390/s21165381] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/20/2021] [Accepted: 08/01/2021] [Indexed: 02/03/2023]
Abstract
This paper investigates the classification of radiographic images with eleven convolutional neural network (CNN) architectures (GoogleNet, VGG-19, AlexNet, SqueezeNet, ResNet-18, Inception-v3, ResNet-50, VGG-16, ResNet-101, DenseNet-201 and Inception-ResNet-v2). The CNNs were used to classify a series of wrist radiographs from the Stanford Musculoskeletal Radiographs (MURA) dataset into two classes-normal and abnormal. The architectures were compared for different hyper-parameters against accuracy and Cohen's kappa coefficient. The best two results were then explored with data augmentation. Without the use of augmentation, the best results were provided by Inception-ResNet-v2 (Mean accuracy = 0.723, Mean kappa = 0.506). These were significantly improved with augmentation to Inception-ResNet-v2 (Mean accuracy = 0.857, Mean kappa = 0.703). Finally, Class Activation Mapping was applied to interpret activation of the network against the location of an anomaly in the radiographs.
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Affiliation(s)
- Ananda Ananda
- giCentre, Department of Computer Science, School of Mathematics, Computer Science and Engineering, City, University of London, London EC1V 0HB, UK; (K.H.N.); (C.K.)
| | - Kwun Ho Ngan
- giCentre, Department of Computer Science, School of Mathematics, Computer Science and Engineering, City, University of London, London EC1V 0HB, UK; (K.H.N.); (C.K.)
| | - Cefa Karabağ
- giCentre, Department of Computer Science, School of Mathematics, Computer Science and Engineering, City, University of London, London EC1V 0HB, UK; (K.H.N.); (C.K.)
| | - Aram Ter-Sarkisov
- CitAI Research Centre, Department of Computer Science, School of Mathematics, Computer Science and Engineering, City, University of London, London EC1V 0HB, UK; (A.T.-S.); (E.A.)
| | - Eduardo Alonso
- CitAI Research Centre, Department of Computer Science, School of Mathematics, Computer Science and Engineering, City, University of London, London EC1V 0HB, UK; (A.T.-S.); (E.A.)
| | - Constantino Carlos Reyes-Aldasoro
- giCentre, Department of Computer Science, School of Mathematics, Computer Science and Engineering, City, University of London, London EC1V 0HB, UK; (K.H.N.); (C.K.)
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Internal fixation of metacarpal fractures using wide awake local anesthesia and no tourniquet. HAND SURGERY & REHABILITATION 2020; 39:214-217. [PMID: 32070790 DOI: 10.1016/j.hansur.2020.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/23/2019] [Accepted: 01/06/2020] [Indexed: 11/24/2022]
Abstract
We sought to report on the use of wide-awake local anesthesia and no tourniquet (WALANT) for internal fixation of metacarpal fractures. We retrospectively examined 10 patients with metacarpal fractures that required either closed reduction and internal fixation (CRIF) or open reduction and internal fixation (ORIF). WALANT was administered 20minutes before the surgery outside the operating room. Once the area was numb, an open or closed reduction was made followed by internal fixation of the fracture using plating, intramedullary screws or Kirshner wires (K-wires). We used intraoperative X-ray to confirm anatomic reduction and correct internal fixation. After proper reduction and fixation, the active range of motion (AROM) was assessed while the patient was awake. Patients were discharged the next day after evaluating their neurovascular status and establishing pain control. Follow-up evaluations were carried out at 2, 6 and 12 weeks postoperatively. All individuals underwent uneventful operations. No significant pain or bleeding was recorded during the operation. Nine out of ten patients regained full AROM at the 12-week follow-up visit in the outpatient clinic. One patient still had slight reduction of range of motion (ROM) of the 5th metacarpophalangeal joint. No neurovascular damage or surgical site morbidity was recorded. CRIF and ORIF of simple metacarpal fractures can be executed successfully using WALANT with good functional results without increased morbidity compared to monitored anesthesia care.
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Rundgren J, Mellstrand Navarro C, Ponzer S, Regberg A, Serenius S, Enocson A. Regional or General Anesthesia in the Surgical Treatment of Distal Radial Fractures: A Randomized Clinical Trial. J Bone Joint Surg Am 2019; 101:1168-1176. [PMID: 31274718 DOI: 10.2106/jbjs.18.00984] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most patients undergoing surgery for the treatment of a distal radial fracture are treated in a day-surgery setting and are given either general anesthesia (GA) or regional anesthesia (RA). The main purpose of this study was to investigate the impact of the anesthesia method on patients' postoperative opioid consumption during the first 3 days following surgery. METHODS This was a single-center randomized clinical trial. A total of 88 patients aged 18 to 74 years who were undergoing day surgery for the treatment of a displaced distal radial fracture with volar-plate fixation were randomized to GA (n = 44) or RA with a supraclavicular brachial plexus blockade (n = 44). The primary outcome was total opioid equivalent consumption (OEC) during the first 3 postoperative days (72 hours). Secondary outcomes included OEC during days 1, 2, and 3, visual analog scale (VAS) for pain scores, maximum pain, postoperative nausea and vomiting, perioperative time consumption (surgical, preoperative, and postoperative anesthesia care time), functional outcomes, and Patient-Rated Wrist Evaluation (PRWE) and EuroQol-5 Dimensions-3 Levels (EQ-5D-3L) scores up to 6 months. RESULTS The total median OEC during the first 3 postoperative days was 85 mg (range, 0 to 218 mg) in the GA group and 60 mg (range, 3 to 150 mg) in the RA group (p = 0.1). The groups differed significantly in OEC and VAS for pain scores during the first 24 hours after surgery; the median OEC was higher in the GA group before discharge (p < 0.001), while it was higher in the RA group after discharge (p < 0.001). Patients in the GA group reported more pain immediately after surgery (median score, 6; width of interquartile range [IQR], 7) and at 2 hours postoperatively (median score, 2; width of IQR, 3) compared with patients in the RA group (median score, 0; width of IQR, 0 at both time points) (p < 0.001). Maximum pain occurred at a median of 1 hour (range, 1 hour to 22 hours) after the end of surgery in the GA group compared with a median of 11 hours (range, 1 hour to 24 hours) in the RA group (p < 0.001). The total median perioperative time consumption was 244 minutes (range, 114 to 389 minutes) in the GA group compared with 146 minutes (range, 74 to 390 minutes) in the RA group (p < 0.001). There were no significant differences in functional outcomes or PRWE or EQ-5D-3L scores at 6 months. CONCLUSIONS The anesthesia method (GA vs. RA) significantly influenced the early patterns of postoperative pain and opioid consumption after surgical treatment of a distal radial fracture, but neither total OEC over the first 3 postoperative days nor longer-term outcomes differed between the groups. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Johanna Rundgren
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Departments of Orthopedics (J.R. and S.P.), Hand Surgery (C.M.N.), and Anesthesiology and Intensive Care (A.R. and S.S.), Södersjukhuset, Stockholm, Sweden
| | - Cecilia Mellstrand Navarro
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Departments of Orthopedics (J.R. and S.P.), Hand Surgery (C.M.N.), and Anesthesiology and Intensive Care (A.R. and S.S.), Södersjukhuset, Stockholm, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Departments of Orthopedics (J.R. and S.P.), Hand Surgery (C.M.N.), and Anesthesiology and Intensive Care (A.R. and S.S.), Södersjukhuset, Stockholm, Sweden
| | - Alf Regberg
- Departments of Orthopedics (J.R. and S.P.), Hand Surgery (C.M.N.), and Anesthesiology and Intensive Care (A.R. and S.S.), Södersjukhuset, Stockholm, Sweden
| | - Stephan Serenius
- Departments of Orthopedics (J.R. and S.P.), Hand Surgery (C.M.N.), and Anesthesiology and Intensive Care (A.R. and S.S.), Södersjukhuset, Stockholm, Sweden
| | - Anders Enocson
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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