Analgesia After Wrist Arthroscopy: A Randomized Control Trial (SS-46)

Introduction Wrist block has been used to provide pain relief for many procedures on the hand and wrist but its role in arthroscopy remains unexplored. We aimed to evaluate and compare the analgesic effect of portal and wrist joint infiltration to the pain relief provided by a wrist block (WB) after wrist arthroscopy. Methods Ethical approval was obtained from the local research ethics committee. A prospective, randomized, double-blind clinical trial was designed and patients undergoing wrist arthroscopy as day cases were recruited for the study. 10 milliliters of 0.5% levo-bupivacaine (Chirocaine) was used for infiltration of the portals and the wrist joint after the procedure or 15 milliliters for the WB before the procedure. The effects were evaluated using the 10 points Visual Analog Score (VAS) score. The primary outcomes for statistical analyses were pain scores, average pain score, area under the curve pain scores, and duration of effect. Results We provide demographic data for patients undergoing these procedures in our unit, outcomes of both techniques of analgesia and finally compare the VAS scores and duration of the analgesia. There were no statistically significant differences between the two groups with respect to age, weight, gender, and duration of surgery. The results should allow us to standardize the technique for pain relief in these patients and allow patients to make an informed choice. Conclusion Wrist arthroscopy is the gold standard in diagnosis and treatment of carpal ligament injuries and its role is continuously being expanded. Concerns have been raised in animal and human in vitro studies with regards to chondrotoxicity of the local anesthetic agents on joint infiltration. We believe both techniques provide satisfactory pain relief but WB does not expose the patients to the potential risk of chondrotoxicity and hence should be used instead of joint infiltration.