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Regional Versus General Anesthesia and the Incidence of Unplanned Health Care Resource Utilization for Postoperative Pain After Wrist Fracture Surgery: Results From a Retrospective Quality Improvement Project
  1. Sarah Sunderland, MD,
  2. Cynthia H. Yarnold, MD,
  3. Stephen J. Head, MD,
  4. Jill A. Osborn, MD, PhD,
  5. Andrew Purssell, PhD,
  6. John K. Peel, BHSc and
  7. Stephan K.W. Schwarz, MD, PhD
  1. From the Department of Anesthesia, Division of Regional Anesthesia, St. Paul's Hospital; and Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
  1. Address correspondence to: Stephan K.W. Schwarz, MD, PhD, Department of Anesthesia, St. Paul's Hospital, Providence Level 3, 1081 Burrard St, Vancouver, British Columbia, Canada V6Z 1Y6 (e-mail:{at}


Background and Objectives The establishment at our center of a dedicated regional anesthesia service in 2008–2009 has resulted in a marked increase in single-shot brachial plexus blocks (sBPBs) for ambulatory wrist fracture surgery. Despite the documented benefits of regional over general anesthesia (GA), there has been a perceived increase among sBPB patients in postoperative return rates for pain at our institution. We conducted a retrospective quality improvement project to examine this.

Methods After exemption from human ethics board review, we sought to identify and contact all wrist fracture surgery patients treated at our center between 2003 and 2012. Our primary outcome was the incidence of unplanned physician visits (office/clinic or emergency department) for pain in the first 48 hours after surgery. Other main outcomes included the incidence of seeking any form of medical attention for pain and self-reporting of severe pain in the first 48 hours.

Results Of 1008 identified patients, 419 could be contacted; 195 qualified for analysis. The incidence of unplanned physician visits in the first 48 hours was 12% (13 of 118) among sBPB patients versus 4% (3 of 77) in GA patients (odds ratio [OR], 3.1; 95% confidence interval [95% CI], 0.8–11.1; P = 0.11). More sBPB versus GA patients sought any form of medical attention for pain (20% vs 5%; OR, 4.7; 95% CI, 1.4–10.9; P = 0.003). Similarly, more sBPB patients reported severe postoperative pain (41% vs 10%; OR, 5.9; 95% CI, 2.6–13.4; P < 0.0001).

Conclusions Patients who received sBPBs for ambulatory wrist fracture surgery had a higher rate of unplanned health care resource utilization caused by pain after hospital discharge than those undergoing GA. These findings warrant confirmation in a prospective trial and emphasize the need for a defined postdischarge analgesic pathway as well as the potential merits of perineural home catheters.

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  • The authors declare no conflict of interest.

    This study was funded by the Department of Anesthesia, St. Paul's Hospital, Vancouver, British Columbia, Canada. Dr Schwarz holds the Dr Jean Templeton Hugill Chair in Anesthesia, supported by the Dr Jean Templeton Hugill Endowment for Anesthesia Memorial Fund.

    This work was presented in abstract form at the 2015 Whistler Anesthesiology Summit, Whistler, British Columbia, Canada; February 26–March 1, 2015.