Continuous Popliteal Sciatic Nerve Block Versus Single Injection Nerve Block for Ankle Fracture Surgery: A Prospective Randomized Comparative Trial.

OBJECTIVES

To compare rebound pain and the need for narcotic analgesia after ankle fracture surgery for patients receiving perioperative analgesia through either a continuous infusion or a single injection nerve block.

DESIGN

Prospective randomized controlled trial.

SETTINGS: Surgeries were performed at 2 hospitals affiliated with a large urban academic medical center.

PATIENTS/

PARTICIPANTS

Fifty patients undergoing operative fixation of an ankle fracture (AO/OTA type 44).

INTERVENTION: Participants were randomized to receive either a popliteal sciatic nerve block as a single shot (SSB group) or a continuous infusion through an On Q continuous infusion pump (On Q group).

MAIN OUTCOME MEASUREMENTS: Visual analog scale and numeric rating scale (0-10) pain levels and amount of pain medication taken.

RESULTS

For all time points after discharge, mean postoperative pain scores and number of pain pills taken were lower in the On Q group versus the SSB group. Pain scores were significantly lower in the On Q group at the 12 hours postoperative time point (P = 0.002) and at 2 weeks postoperatively. The number of pain pills taken in the first 72 hours was lower in the On Q group (14.9 vs. 20.0; P = 0.036). Overall, 7/23 patients in the On Q group had their pump malfunction and 1 patient accidently removed the catheter.

CONCLUSIONS

Use of continuously infused regional anesthetic for pain control in ankle fracture surgery significantly reduces "rebound pain" and the need for oral opioid analgesia compared with single-shot regional anesthetic.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.