Local/Regional Anesthesia Versus General Anesthesia in Phalanx Fractures/Dislocations

Area of Science:

• Orthopedic Surgery
• Anesthesiology

Background:

• Traditional phalanx fracture repair utilized general anesthesia.
• Wide-awake Local Anesthesia No Tourniquet (WALANT) presents an alternative for patients where general anesthesia is contraindicated or undesirable.
• Regional/local anesthesia may mitigate comorbidities associated with general anesthesia.

Purpose of the Study:

• To compare the outcomes and adverse events of local/regional anesthesia versus general anesthesia for phalanx fracture/dislocation repair.
• To test the hypothesis that local/regional anesthesia yields comparable outcomes and fewer adverse events than general anesthesia.

Main Methods:

• Retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2015-2019).
• Inclusion of patients undergoing operative fixation for phalanx fracture or dislocation, stratified by anesthesia type (local/regional vs. general).
• Analysis of preoperative demographic data and 30-day postoperative complications.

Main Results:

• A total of 2831 patients were analyzed; 13% received local/regional anesthesia, 87% received general anesthesia.
• No clinically significant differences in surgical site occurrences were observed between the two anesthesia groups.
• Low rates of 30-day postoperative complications were reported for both cohorts, including deep vein thrombosis (0.03%) and pulmonary embolism (0.02%) in the local/regional group, and pneumonia (0.12%) and stroke (0.08%) in the general anesthesia group.

Conclusions:

• Local/regional anesthesia techniques are safe for surgical repair of phalanx fractures and dislocations.
• These techniques provide a viable alternative to general anesthesia, especially when general anesthesia is undesirable.
• Postoperative complication rates within 30 days are comparable between local/regional and general anesthesia approaches for phalanx surgery.