An opioid-free anaesthetic using nerve blocks enhances rapid recovery after minor hand surgery in children

Background and objective The aim of this prospective randomized study was to evaluate the quality of analgesia, postoperative comfort and subsequent duration of hospitalization after distal hand surgery and peripheral nerve block at the wrist for paediatric outpatients. Methods Sixty consecutive ASA I or II children were randomly assigned to the following groups: in group B (block), intraoperative and postoperative analgesia was provided by peripheral nerve block; and in group O (opioids), intraoperative and postoperative analgesia was provided by intravenous opioids. The patients' age, sex and type of surgery were recorded as were the postoperative pain management and postoperative vomiting. Time to discharge from the recovery room, the postoperative ward and the time to discharge home were also noted. Results The two groups were similar with respect to age, sex, ASA physical status, weight, height and types of injuries. The incidence of postoperative pain (CHEOPS score >= 7) and the incidence of postoperative vomiting were significantly higher in group O than in group B: 26.6 versus 3.3%; P-0.025, and 33.3 versus 6.6%; P=0.011, respectively. The time before oral intake was significantly longer in group O than in group B [ 187 (75-265) min versus 60 (32-125) min, respectively, P=0.0002]. The time to meet discharge home criteria was 277 (230-330) min in group O versus 210 (145-260) min in group B (P=0.0039). Conclusion The present study demonstrates for the first time that, after distal hand surgery in children, peripheral nerve block improves pain management, opioid analgesia-induced side effects and provides a shorter postoperative recovery time than systemic analgesia with opioids. Eur J Anaesthesiol 2010;27:521-525