Does intravenous patient-controlled analgesia or continuous block prevent rebound pain following infraclavicular brachial plexus block after distal radius fracture fixation? A prospective randomized controlled trial.

研究概要

Sixty-six patients with displaced distal radius fractures treated with volar plate fixation were randomized to a single infraclavicular block (BPB only; n=22), BPB plus opioid-based IV patient-controlled analgesia (PCA) (n=22), or brachial plexus block (BPB) plus continuous infraclavicular block (n=22). The primary outcome was pain (VAS) at 12 hours; secondary outcomes included opioid-equivalent consumption (OEC) at prespecified intervals through 48 hours and cumulatively to two weeks, plus complications. Pain and medication use were recorded at 4, 6, 9, 12, 24, 48 hours and two weeks. Overall, the results showed less rebound pain at 9–12 hours with continuous block versus BPB only, and lower 9–12 hour OEC with either IV PCA or continuous block versus BPB only; however, total two-week OEC was highest with IV PCA. In short, continuous infraclavicular infusion mitigated rebound pain without increasing overall opioid use, whereas IV PCA controlled early pain but increased total opioid exposure.