Peripheral Neuromodulation and Opioid Sparing Strategies for Mitigating Perioperative Pain in the Stabilization and Hardware Removal of Complex Trimalleolar Fractures: A Case Report.

Individualized opioid-free perioperative management, combining dual continuous peripheral nerve catheters targeting the popliteal sciatic and adductor canal nerves, non-opioid pharmacologic agents, and adjunctive neuromodulation, offers robust multimodal analgesia. This approach supports both ORIF and hardware removal in complex trimalleolar fractures while preserving function, reducing opioid-related risks, and promoting faster recovery.