Comparative Analysis of Anesthesia Techniques in Radio-Ulnar Surgeries: A Focus on General Anesthesia vs. Bier’s Block

Abstract

Background: Forearm surgeries involving the radius and ulna, including fracture fixations, osteotomies, and joint reconstructions, demand a well-considered anesthetic plan to ensure safe and smooth surgical outcomes. Among the available options, General Anesthesia (GA) and Bier’s Block (intravenous regional anesthesia) represent the two most widely practiced approaches in this clinical setting. The present study was undertaken to assess which technique is more commonly adopted and to explore the key clinical variables that drive this decision. Objectives: This study aimed to determine the more frequently used anesthesia method in radio-ulnar surgical procedures, specifically comparing General Anesthesia with Bier’s Block. Secondary objectives included identifying the factors that guide anesthesia selection, assessing intraoperative and postoperative complication profiles, and evaluating patient recovery patterns following each technique. Methodology: A descriptive cross-sectional study was carried out at two tertiary care hospitals in Faisalabad, namely Civil Hospital and Madina Teaching Hospital. A total of 100 patients who underwent radio-ulnar surgical procedures were enrolled through consecutive sampling, provided they met the predefined inclusion criteria. Patient demographics, type of surgical procedure, coexisting medical conditions, and the anesthesia administered were documented systematically. Statistical analysis was conducted using SPSS version 26. Descriptive statistics including frequencies and cross-tabulations were used to summarize patient characteristics. An independent samples t-test was applied to compare the mean recovery time between patients who received General Anesthesia and those who received Bier's Block. A chi-square test was used to assess the association between anesthesia type and the occurrence of complications. Results with a p-value below 0.05 were considered statistically significant. Results: Out of 100 cases reviewed, General Anesthesia was administered to 64 patients (64%) while Bier’s Block was used in the remaining 36 (36%). Surgical duration proved to be the single most decisive factor in anesthesia selection, cited by 59% of respondents, followed by patient comorbidities (24%) and fracture location (14%). When complication risk was assessed, bleeding disorders were identified by 23% of clinicians as the chief concern, cardiac abnormalities by 11%, and nerve-related complications by 5%. Nearly half the patients (48%) achieved recovery within the first 30 minutes, while only 2% required more than two hours, which is classified as delayed recovery. Additional anesthetic techniques such as TIVA (28%), brachial plexus block (4%), and axillary block (3%) were reported in selected cases. Conclusion: General Anesthesia proved to be the more commonly utilized technique in radio-ulnar surgeries, largely driven by the extended duration of most procedures. Bier’s Block, while effective, is better suited to shorter interventions. The main complications observed encompassed bleeding disorders, cardiac abnormalities, and nerve injury. These findings reinforce the need for individualized, team-based anesthesia planning. Prospective multicenter studies are recommended to develop evidence-driven anesthesia guidelines for this surgical category.