This article is more than 5 years old. Information may no longer be current.
Rebound pain seen with popliteal blocks used during ORIF of ankle fractures
Click Here to Manage Email Alerts
SAN ANTONIO — Popliteal blocks provide equivalent pain control to general anesthesia alone during open reduction and internal fixation of ankle fractures until 12 to 24 hours postoperatively, when popliteal blocks may cause rebound pain to occur, according to a study presented at the 2011 Annual Meeting of the Orthopaedic Trauma Association.
“Postoperative pain management after ankle fracture fixation often requires narcotic administration and may even require overnight hospitalization,” Rachel Y. Goldstein, MD, MPH, an investigator for the study, said during her presentation. “However, regional blocks can provide successful pain control for a wide variety of orthopedic procedures. Previous studies have demonstrated that this technique has proven successful in up to 97% of patients.”
To test the efficacy of popliteal blocks against general anesthesia alone, Goldstein and colleagues conducted a level 1 study of 43 patients undergoing open reduction and internal fixation for ankle fractures. The team randomized patients to receive either a popliteal block or intravenous sedation and general anesthesia. Of the patients, 21 received popliteal blocks and 22 received general anesthesia. The team quantified pain at 2 hours, 4 hours, 8 hours, 12 hours, 24 hours and 48 hours postoperatively using the visual analog scale (VAS).
At 4 hours postoperatively, patients who received general anesthesia had higher VAS scores for pain compared with the popliteal block group. However, by 24 hours postoperatively, those patients who received popliteal blocks experienced greater pain on VAS.
“Popliteal block provides superior pain control compared to general anesthesia alone,” Goldstein said. “However, patients who received popliteal block experienced a dramatic increase in pain in the first 8 to 24 hours, while patients who received anesthesia alone experienced a steady decrease in their pain. Understanding and preparing for rebound pain will allow patients to have more effective postoperative pain control.”
Reference:
- Goldstein RY, Montero N, McLaurin TM, Egol KA, Tejwani NC. Efficacy of popliteal bloack in postoperative pain control after ankle fracture fixation: A prospective randomized study. Paper #62. Presented at the 2011 Annual Meeting of the Orthopaedic Trauma Association. Oct. 12-15. San Antonio.
Follow
OrthoSuperSite.com on Twitter