radius fracture anesthesia and rehabilitation (radar)

Conditions: Radial Fracture

Summary: distal fracture of the radial bone is the commonest fracture and is also connected to osteoporosis. normally the operation is performed under neuroaxial blockade and sedation. when the blockade rapidly vanish many patients experience a rebound pain much severer that than the actual trauma pain. if long acting local anesthetics are used this will occur during night time and many patients will go to the emergency room for pain treatment. short acting local anesthetics may make it possible to treat patients pain in-house prior to leaving the hospital. in this study

this investigation is a joint study involving occupational therapist, orthopedic surgeons and anesthesiologist. distal fracture of the radial bone is the commonest fracture, mainly in elder females with osteoporosis and also obesity. normally 75% of patients are treated with plaster after fracture repositioning. the remaining 25% are operated upon. routinely, the operation is performed under neuroaxial blockade and sedation. when the blockade rapidly vanish many patients experience a rebound pain much severer than the initial trauma pain. if long acting local anesthetics are used the blockade will be terminated during night and many patients will go to the emergency room for pain treatment. short acting local anesthetics may make it possible to treat patients pain in-house prior to hospital discharge and thus reduce severe rebound pain. in this study patients with radial fractures are included and operated upon by a standard surgical operation with plate and screws. they will receive either 1) ultra sound guided supraclavicular block long-acting (n=30) local anesthetic , 2) ultra sound guided supraclavicular block short-acing (n=60) local anesthetics or 3) general anesthesia (n=30) to provide analgesia during the operational procedure. patients given an ultra sound guided blockade with short-acting local anesthetic (n=60) are further sub-divided into receiving either postoperative plaster/cast (n=30) or an orthosis/brace (n=30). patients pain will be measured by numeric rating scale (0 = no pain and 10 worst possible pain) during the first 7 postoperative days. the opioid consumption will be noted by personal contact intermittently by telephone and by a pain diary until day 7. both parametric and none-parametric analysis will be conducted. quality of recovery will be assessed by quality of recovery scale 15 at 5 occasions. adverse effects and unplanned health care contacts will also be gathered. after 3 days the occupational therapist will control the patients followed by investigations at 2, 6 12 and 52 weeks. the patients will be graded the patient rated wrist evaluation (prwe) and michigan outcomes questionnaire (mhq) edema will be measured and strength will be measured by jamar dynamometer, finally, sense of coherence will be measured by kasam-13

Eligibility criteria:
inclusion criteria: * understands native language * cognitive intact * fracture types ao 23..a and ao 23.c.1 * operated within 18 days from initial trauma exclusion criteria: * not fulfilling inclusion criterias * high energy trauma * ligament injury

Keywords: radial fracture anesthetic plaster cast orthosis brace postoperative pain quality of recovery