Enhanced Recovery after Distal Radius Fracture Surgery using Combined Short- and Long-Acting Nerve Blocks: a Randomized Controlled Trial.

BACKGROUND

Distal radius fractures are commonly treated under regional anesthesia; however, conventional approaches face limitations, including prolonged motor block with long-acting agents and pain rebound with short-acting agents.

OBJECTIVE

To investigate whether combining a short-acting axillary block with long-acting truncal blocks at the elbow (median and radial nerves) is equivalent to a long-acting axillary block alone for postoperative pain management after distal radius fracture surgery.

STUDY

DESIGN

Multicenter, prospective, randomized, open-label, parallel-group, controlled, equivalence trial.

SETTING

Seven secondary care centers in France.

PATIENTS: 150 adults scheduled for wrist fracture osteosynthesis.

INTERVENTIONS: Patients were randomized to a long-acting axillary block alone (BAX-Alone) or a short-acting axillary block combined with long-acting median and radial nerve truncal blocks at the elbow (BAX-Asso).

MAIN OUTCOME MEASURES: Pain intensity at motor block resolution (numerical rating scale, 0-10).

RESULTS

128 patients were analyzed (62 BAX-Alone, 66 BAX-Asso). Pain scores at motor block resolution were similar (2.18 ± 2.35vs. 2.49 ± 3.22; mean difference 0.31, 95% CI - 0.69 to 1.31); equivalence was not formally concluded. Motor block recovery was significantly shorter in BAX-Asso (4 [2-6] vs. 15 [10-19] hours, P <  0.001). Block success rates were comparable (91% vs. 98%, P =  0.08), with no difference in opioid consumption or severe pain incidence.

CONCLUSIONS

Combining a short-acting axillary block with long-acting truncal blocks at the elbow achieves significantly faster motor recovery, while maintaining the quality of postoperative pain relief, offering a clinically relevant advantage in outpatient wrist fracture surgery.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT04046744.