Faculty Bibliography

OBJECTIVES: To compare rebound pain and the need for narcotic analgesia following 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 two hospitals affiliated with a large urban academic medical center. PATIENTS/PARTICIPANTS: 50 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 vs. the SSB group. Pain scores were significantly lower in the On Q group at the 12 hour 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 one patient accidently removed their 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 to single-shot regional anesthetic. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

OBJECTIVES: : To compare postoperative pain control in patients treated surgically for ankle fractures who receive popliteal blocks with those who received general anesthesia alone. DESIGN: : Institutional Review Board approved prospective randomized study. SETTING: : Metropolitan tertiary-care referral center. PATIENTS: : All patients being treated with open reduction internal fixation for ankle fractures who met inclusion criteria and consented to participate were enrolled. INTERVENTIONS: : Patients were randomized to receive either general anesthesia (GETA) or intravenous sedation and popliteal block. MAIN OUTCOME MEASURES: : Patients were assessed for duration of procedure, total time in the operating room, and postoperative pain at 2, 4, 8, 12, 24, and 48 hours after surgery using a visual analog scale. RESULTS: : Fifty-one patients agreed to participate in the study. Twenty-five patients received popliteal block, while 26 patients received GETA. There were no anesthesia-related complications. At 2, 4, and 8 hours postoperatively, patients who underwent GETA demonstrated significantly higher pain. At 12 hours, there was no significant difference between the 2 groups with regard to pain control. However, by 24 hours, those who had received popliteal blocks had significantly higher pain with no difference by 48 hours. 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 "rebound pain" with early narcotic administration may allow patients to have more effective postoperative pain control. LEVEL OF EVIDENCE: : Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

PURPOSE: Ultrasound technology has been applied to increase both efficacy and safety of certain peripheral nerve blocks. This case report describes the first successful ultrasound-guided lumber plexus block. CLINICAL FEATURES: We describe a 91-year-old woman with aortic stenosis who successfully underwent open reduction and internal fixation of a fractured right hip with a lumbar plexus block. Ultrasound provided direct visualization to help identify the anatomical structures and guide the block needle during performance of the block. Complete block of the lumbar plexus was attained within 15 min, and the surgical procedure was performed uneventfully. CONCLUSION: The use of ultrasound has gained popularity to perform peripheral nerve blocks. In this case report, a successful lumbar plexus block was performed with ultrasound guidance. By direct visualization, using this technology may potentially reduce complications associated with lumbar plexus blocks