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Efficacy of popliteal block in postoperative pain control after ankle fracture fixation: a prospective randomized study.

Research paper by Rachel Y RY Goldstein, Nicole N Montero, Sudheer K SK Jain, Kenneth A KA Egol, Nirmal C NC Tejwani

Indexed on: 27 Jun '12Published on: 27 Jun '12Published in: Journal of orthopaedic trauma



Abstract

To compare postoperative pain control in patients treated surgically for ankle fractures who receive popliteal blocks with those who received general anesthesia alone.Institutional Review Board approved prospective randomized study.Metropolitan tertiary-care referral center.All patients being treated with open reduction internal fixation for ankle fractures who met inclusion criteria and consented to participate were enrolled.Patients were randomized to receive either general anesthesia (GETA) or intravenous sedation and popliteal block.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.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.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.