Wrist surgery pain relief showdown: which block works best?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * American Society of Anesthesiologist (ASA) status I-III * Age 18-90 years old * Scheduled for distal radial fracture fixation (Open reduction and internal fixation with volar approaching locking plate) * Informed consent obtained * Patients identified to be at an elevated risk of suffering from poor postoperative pain control. Patients with one or more of the following risk factors: * Severe preoperative pain: defined as worse numerical rating scale (NRS) pain score equal or higher than 6/10 with arm movements at day before surgery. * Preoperative use of opioid: use of strong opioids such as morphine, oxycodone * Depressive symptoms: Patient health questionnaire (PHQ-9) score of 10 or above * Anxiety symptoms: General Anxiety Disorder (GAD-7) score of 10 or above * Higher energy and high-grade fracture cases - road traffic accident, fall from height, open fractures, combined distal radius and distal ulna fractures, fractures requiring external fixation, fractures with severe articular comminution or severe metaphyseal extension, comminuted fractures requiring more than a single volar approach incision and a single volar locking plate implant Exclusion Criteria: * Revision surgery * Previous fractures or surgery in the affected distal radius * Surgery involving more than the affected arm * Cases with baseline (pre-injury) QuickDASH score worse (higher) than 10 out of 100 * Respiratory compromise (requires long term oxygen) * History of seizures * Pre-existing neurological disorder/deficit * Alcohol or substance abuse * Impaired mental state * Local infection * Allergy to analgesic drugs: local anaesthetic drugs, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), opioids * Impaired renal function (defined as effective glomerular filtration rate \< 30ml/min/1.73m2 * Impaired liver function (defined as plasma bilirubin over 34μmol/L; international normalized ratio \[INR\] ≥1.7, alanine aminotransferase \[ALT\] over 100U/L, aspartate aminotransferase \[AST\] over 100U/L) * Coagulopathy (platelet count \<100,000/ml and/or INR ≥ 1.5) or the use of anticoagulants (not including aspirin) that precludes the use of supraclavicular BPB * Pregnancy * Patient refusal for regional nerve blocks * Patient refusal to join the clinical trial * Patient unable/unwilling to attend post-op rehabilitation programme