Lee Ryan, Lee Danny, Ramamurti Pradip, Fassihi Safa, Heyer Jessica H, Stadecker Monica, Webber Michael, Hughes Alice, Pandarinath Rajeev
The George Washington University School of Medicine and Health Sciences, The George Washington University in Washington, 2300 M St, Washington, DC, 20037, USA.
Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System in Miami, Miami, FL, USA.
Eur J Trauma Emerg Surg. 2022 Dec;48(6):4569-4576. doi: 10.1007/s00068-021-01704-1. Epub 2021 May 29.
Open reduction and internal fixation (ORIF) are commonly utilized for the repair of distal radius fractures (DRF). While general anesthesia (GA) is typically administered for ORIF, recent studies have also demonstrated promising results with the usage of regional anesthesia (RA) in the surgical treatment of distal radius fractures. This study will compare complication rates between the use of RA versus GA for ORIF of DRFs.
A multi-institutional surgical registry was utilized to identify patients who had undergone ORIF for DRFs from 2005 to 2018-these patients were stratified into GA and RA cohorts. Patients were matched utilizing coarsened-exact-matching (CEM) to compare postoperative outcomes and rates of 30-day complications were compared between the two cohorts.
Upon CEM-matching, 1191 patients receiving RA were matched to 9250 patients who had received GA, with a multivariate imbalance measure (L1) statistic of < 0.001. In the matched-cohort analysis, no significant differences were observed in rates of any complication (all p ≥ 0.083). On multivariate regression analyses, RA was not associated with increased risk for any complication (p = 0.445), minor complications (p = 0.093), major complications (p = 0.758), unplanned reoperations (p = 0.355), unplanned readmissions (p = 0.799), or mortality (p = 0.579).
With similar safety profiles, RA is a safe and reasonable alternative to GA when managing DRFs surgically. RA may be the preferred anesthetic technique for ORIF of DRFs in patients at high risk with GA, such as those with reactions to GA in the past or with significant cardiopulmonary risk factors.
切开复位内固定术（ORIF）常用于桡骨远端骨折（DRF）的修复。虽然ORIF通常采用全身麻醉（GA），但最近的研究也表明，区域麻醉（RA）在桡骨远端骨折的手术治疗中也取得了令人满意的效果。本研究将比较RA与GA用于DRF的ORIF时的并发症发生率。
利用多机构手术登记系统识别2005年至2018年接受DRF的ORIF的患者，这些患者被分为GA组和RA组。采用精确粗匹配（CEM）对患者进行匹配，以比较术后结果，并比较两组30天并发症的发生率。
经CEM匹配后，1191例接受RA的患者与9250例接受GA的患者相匹配，多变量不平衡测量（L1）统计量<0.001。在匹配队列分析中，未观察到任何并发症发生率的显著差异（所有p≥0.083）。在多变量回归分析中，RA与任何并发症（p = 0.445）、轻微并发症（p = 0.093）、严重并发症（p = 0.758）、计划外再次手术（p = 0.355）、计划外再次入院（p = 0.799）或死亡率（p = 0.579）的风险增加无关。
由于安全性相似，RA在手术治疗DRF时是GA的一种安全合理的替代方法。对于有GA高风险的患者，如过去有GA反应或有重大心肺危险因素的患者，RA可能是DRF的ORIF的首选麻醉技术。
