On arrival continuous brachial plexus block provides superior analgesia with reduced persistent postsurgical pain in complex hand injuries: A randomized controlled trial.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(15):10 J Trauma Acute Care Surg . 2025 Jun 1;98(6):934-941.What this means for my practice?
Early initiation of continuous brachial plexus block in complex hand trauma offers significantly better pain control, shortens time to surgery, reduces persistent postsurgical pain, and increases patient satisfaction. Clinically, integrating on-arrival continuous nerve blocks can improve acute and long-term outcomes in hand trauma care. Limitations include lack of continuous infusion (intermittent boluses used), and follow-up did not assess chronic pain or rehabilitation outcomes.
Study Summary
Eighty adult patients with complex unilateral hand injuries were randomized to receive either a continuous infraclavicular brachial plexus block (n=40) or standard intravenous analgesics (n=40). The primary outcome was pain relief 1 hour after intervention. Secondary outcomes included pain during interventions, rescue analgesic use, patient satisfaction, and persistent postsurgical pain (PPSP) at days 15 and 30. Overall, the results of the study revealed that patients in the brachial plexus block group experienced significantly lower pain scores at 1 hour, less breakthrough pain, less need for rescue analgesia, and a lower incidence of PPSP at 30 days. The findings suggest that early use of continuous brachial plexus block enhances analgesia, reduces PPSP, and improves patient satisfaction.
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