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Results support efficacy of continuous infusion of peripheral nerve anesthesia for rebound pain after surgery for ankle fracture

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NEW YORK — Results of a prospective randomized trial presented here indicate use of a continuous popliteal sciatic nerve block reduces rebound pain in patients who underwent surgery for ankle fractures better than a single-injection nerve block.

“Continuous infusion of peripheral nerve anesthesia is a safe and effective way to minimize rebound pain, reduce the need for oral pain medications and improve pain scores,” David Y. Ding, MD, said in a presentation at the International Society for Fracture Repair Meeting.

To evaluate the effect of a continuous infusion of regional anesthetic administered via On-Q pump on alleviating rebound pain and reducing postoperative narcotic use in adults who were operatively treated for ankle fracture, Ding and colleagues randomized 22 patients to receive a popliteal sciatic nerve block as a single injection and 23 patients to receive a continuous infusion.

All patients, surgeons and evaluators were blinded to treatment allocation. The investigators collected data on the patients at various time points between 8 hours and 72 hours after surgery.  

There were no significant differences between the groups for gender, body mass index, Charlson Comorbidity Index or fracture type. The mean age of patients was 39 years in the single-injection group and 50 years in the On-Q pump group.

As reported in other studies, Ding and colleagues found the single-injection group experienced rebound pain at 12 hours to 24 hours postoperatively. At 12 hours, those patients had significantly higher postoperative VAS scores for pain compared to the On-Q pump group.

“The Q pump maintained the pain control constantly throughout the first few days,” Ding said. He added, “The single-shot group also had an average of about seven more Percocets than the On-Q group.”

Investigators discovered eight patients in the On-Q-group who discontinued use of the pump early, around the 24-hour mark. There were no differences between the groups in rates of infection, neurologic symptoms or side-effects from the narcotics – by Gina Brockenbrough, MA

Reference:

Ding DY. Abstract #60. Presented at: International Fracture Repair Society Meeting; May 14-17, 2014; New York.

Disclosure: Ding has no relevant financial disclosures.