Fri., 10/14/11 Knee, Foot & Ankle, Paper #62, 4:21 pm OTA-2011
Δ Efficacy of Popliteal Block in Postoperative Pain Control After Ankle Fracture Fixation: A Prospective Randomized Study
Rachel Y. Goldstein, MD, MPH; Nicole Montero, BA; Toni M. McLaurin, MD;
Kenneth A. Egol, MD; Nirmal C. Tejwani, MD;
NYU Hospital for Joint Diseases, New York, New York, USA
Purpose: Postoperative pain management after ankle fracture fixation often requires narcotic administration and overnight hospitalization. Previous studies have proven the efficacy of regional blocks for a wide variety of knee, ankle, and foot surgeries, and found success rates with popliteal regional block anesthesia for foot and ankle surguries. The purpose of this prospective randomized study was to compare postoperative pain control in patients treated surgically for ankle fractures who receive popliteal blocks with those who received general anesthesia alone.
Methods: All patients being treated with open reduction and internal fixation for ankle fractures at a single institution were asked to participate in this study. Patients who agreed to participate were randomized to receive either general anesthesia (GETA) or intravenous sedation and a popliteal block. Intraoperatively, patients were assessed for location of incisions, duration of procedure, and total time in the operating room. Postoperatively, all patients were monitored for their postoperative pain at 2, 4, 8, 12, 24, and 48 hours after surgery using a visual analog scale (VAS). Patients were also monitored for signs of allergic or toxic reactions and postoperative nausea and vomiting. All patients were followed up to 6 months to confirm fracture healing.
Results: 43 patients agreed to participate in the study; 21 patients received popliteal block, while 22 patients received GETA. The 2 groups were similar with regard to age, sex, type of ankle fracture, and tourniquet time. The popliteal block took 54.86 minutes from the time the patient entered the room until the skin incision was made, while the GETA group took 42.75 minutes (P <0.001). At 4 hours postoperatively, patients who underwent GETA demonstrated significantly higher pain based on VAS (P = 0.017). However, by 24 hours, those who had received popliteal blocks had significantly higher pain (P = 0.05). There was no significant difference between the 2 groups with regard to satisfaction with postoperative pain control.
Conclusions: Popliteal block provides equivalent postoperative pain control to general anesthesia alone in patients undergoing operative fixation of ankle fractures. However, patients who receive popliteal blocks do experience a significant increase in pain between 12 and 24 hours. Recognition of this phenomenon of “rebound pain” with early narcotic administration may allow patients who receive popliteal blocks to have more effective postoperative pain control.
Alphabetical Disclosure Listing (628K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.