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Continuous peripheral nerve anesthesia reduces rebound pain

A third of patients in the continuous anesthesia group discontinued use of the pump early.

Issue: July 2014

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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, of the Hospital for Joint Diseases in New York City, said during a presentation at the International Society for Fracture Repair Congress.

Participants blinded to treatment

To evaluate the effect of a continuous infusion of regional anesthetic administered via On-Q pump (I-Flow LLC; Irvine, Calif.) 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. “For patients with indwelling catheters, we were able to maintain sustained regional anesthesia for 48 hours,” Ding said. The investigators excluded patients who were on chronic opioids and those who had a neurologic condition that could interfere with pain sensation.

All patients, surgeons and evaluators were blinded to treatment allocation. The investigators collected data on the patients at various time points from immediately postoperation to 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.”

Complications

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