Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery

Anesthesiology. 2004 Aug;101(2):461-7. doi: 10.1097/00000542-200408000-00028.


Background: The purpose of this study was to determine whether either regional anesthesia (RA) or general anesthesia (GA) provided the best analgesia with the fewest adverse effects up to 2 weeks after ambulatory hand surgery.

Methods: Patients undergoing ambulatory hand surgery were randomly assigned to RA (axillary brachial plexus block; n = 50) or GA (n = 50). Before surgery, all patients rated their hand pain (visual analog scale) and pain-related disability (Pain-Disability Index). After surgery, eligibility for bypassing the postanesthesia care unit ("fast track") was determined, and pain, adverse effects, and home-readiness scores were measured. On postoperative days 1, 7, and 14, patients documented their pain, opioid consumption, adverse effects, Pain-Disability Index, and satisfaction.

Results: More RA patients were fast-track eligible (P < 0.001), whereas duration of stay in the postanesthesia care unit was shorter in the RA group (P < 0.001). Time to first analgesic request was longer in the RA group (P < 0.001), and opioid consumption was reduced before discharge (P < 0.001). In the RA group, the pain ratings measured at 30, 60, 90, and 120 min after surgery were lower (P < 0.001), and patients spent less time in the hospital after surgery (P < 0.001). More GA patients experienced nausea/vomiting during recovery in the hospital (P < 0.05). However, on postoperative days 1, 7, and 14, there were no differences in pain, opioid consumption, adverse effects, Pain-Disability Index, or satisfaction.

Conclusions: Despite significant reduction in pain before discharge from the hospital after ambulatory hand surgery, single-shot axillary brachial plexus block does not reduce pain at home on postoperative day 1 or up to 14 days after surgery when compared with GA. However, RA does provide other significant early benefits, including reduction in nausea and faster discharge from the hospital.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Ambulatory Surgical Procedures* / adverse effects
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / therapeutic use
  • Anesthesia, Conduction* / adverse effects
  • Anesthesia, General* / adverse effects
  • Codeine / adverse effects
  • Codeine / therapeutic use
  • Female
  • Hand / surgery*
  • Hemodynamics / drug effects
  • Humans
  • Laryngeal Masks
  • Length of Stay
  • Male
  • Middle Aged
  • Oxycodone / adverse effects
  • Oxycodone / therapeutic use
  • Pain Measurement
  • Pain, Postoperative / epidemiology
  • Pain, Postoperative / prevention & control*
  • Sample Size
  • Time Factors
  • Tourniquets


  • Analgesics, Opioid
  • Oxycodone
  • Codeine