The goal of this observational study is to learn about the impact of sarcopenia (muscle loss) on the efficacy of regional nerve blocks and postoperative recovery in patients undergoing upper extremity surgery. The main questions it aims to answer are: 1. Does sarcopenia affect the onset time and success rate of peripheral nerve blocks? 2. How does sarcopenia influence postoperative pain control and opioid consumption compared to patients receiving pure general anesthesia? Participants will undergo a preoperative muscle assessment, which includes a chair stand test and a brief ultrasound of the thigh muscle. Researchers will then observe and record their nerve block onset time (if applicable), postoperative pain scores, and recovery metrics during their hospital stay up to postoperative day 2.
Study Type
OBSERVATIONAL
Enrollment
150
Patients identified with sarcopenia based on preoperative muscle assessment.
Patients with normal muscle mass based on preoperative muscle assessment.
received general anesthesia alone
general anesthesia combined with nerve block
ChangGung Memorial Hospital
Taoyuan, Taiwan
time to first rescue analgesia
Time frame: From the completion of surgery up to Postoperative Day 2
Nerve block onset
Time frame: From the completion of local anesthetic injection up to 30 minutes
Nerve block duration
Time frame: From the successful onset of sensory block to the patient's first report of pain at the surgical site, assessed up to postoperatively day 2
Intraoperative Mean Arterial Pressure (MAP) and Heart Rate (HR)
Mean Arterial Pressure (MAP) measured in mmHg and Heart Rate (HR) measured in beats per minute, assessed continuously using standard non-invasive or invasive hemodynamic monitors.
Time frame: During surgery (From the induction of anesthesia to the end of surgery, an average of 2 hours)
Postoperative NRSFrom the end of surgery up to 48 hours postoperatively.
Time frame: From the end of surgery up to postoperative day 2
Total opioid consumption
Time frame: From the end of surgery up to postoperative day 2
Incidence of Local Anesthetic Systemic Toxicity (LAST)
LAST is defined as the occurrence of adverse central nervous system signs (e.g., altered mental status, seizures, tinnitus) or cardiovascular signs (e.g., arrhythmias, profound hypotension, cardiac arrest) following the administration of local anesthetics. It will be assessed clinically by the attending anesthesiologist and recorded as a binary outcome (Yes/No).
Time frame: From the initiation of nerve block up to 24 hours postoperatively
Incidence of postoperative delirium
The incidence of postoperative delirium will be assessed using the Confusion Assessment Method (CAM). The CAM diagnostic algorithm evaluates four features: (1) acute onset and fluctuating course, (2) inattention, (3) disorganized thinking, and (4) altered level of consciousness. Delirium is considered present if features 1 and 2 are observed, along with either feature 3 or 4. The outcome will be recorded as a binary variable (Yes/No).
Time frame: From the end of surgery up to postoperative day 2
ICU stay
Time frame: From ICU admission up to postoperative day 2
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