Axillary Block in Association With Analgesic Truncal Blocks at the Elbow for Wrist Surgery.

Fractures of the forearm bones that occur around the wrist are common in the elderly. Standard anesthesia for its surgical treatment is regional anesthesia (RA): supraclavicular block, infraclavicular block or axillary block (BAX). However, these techniques have some limitations, such as the postoperative pain management and the non-specificity of the analgesia. Indeed analgesia is not specific to the wrist and extends to the elbow and forearm, preventing rapid recovery of elbow flexion and extension when a long-acting local anesthetic (LA) is used. Recently RA techniques associating proximal anesthetic blocks with distal analgesic blocks have been proposed to serve a dual objective: good anesthesia for surgery and specific analgesia. The hypothesis of this study is that, for the wrist surgery, axillary block using a short-acting LA combined with analgesic blocks at the elbow using a long-acting LA could provide a RA installation time reduction, an optimal surgical comfort, a longer post-operative analgesia duration and a faster recovery from motor block.

Inclusion Criteria: * Patients undergoing wrist fracture surgery under regional anesthesia * Consent for participation * Affiliation to the French social security system Exclusion Criteria: * Chronic use of opiod analgesics * Chronic pain syndrome or fibromyalgia * Contraindication for locoregional anesthesia * Contraindication for opioid * ASA IV * Pregnant or breastfeeding women * Patients under protection of the adults (guardianship, curators or safeguard of justice) * Communication difficulties or neuropsychiatric disorder