Efficacy of Popliteal Block in Postoperative Pain Control After Ankle Fracture Fixation

Goldstein, Rachel Y.; Montero, Nicole; Jain, Sudheer; Egol, Kenneth A; Tejwani, Nirmal C.

doi:10.1097/bot.0b013e3182638b25

Cited by 84 publications

(64 citation statements)

References 19 publications

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“…In contrast to the findings of patients who received general anesthesia, patients who received a brachial plexus blockade which when coupled with increased fentanyl or morphine use in the PACU (increased use compared with the brachial plexus blockade group), these patients were provided with a steady linear downward trend in postoperative pain. This is consistent with other studies comparing single-injection nerve blocks and general anesthesia for other orthopaedic surgeries [10,23]. This finding is important for the understanding, management, and counseling of patients regarding perioperative pain expectations and control.…”

Section: Discussionsupporting

confidence: 91%

“…Even though overall narcotic consumption was not different, because of rebound pain in the brachial plexus blockade group shortly after surgery, these patients might need to be educated on the importance of taking their oral analgesics before the onset of pain. Echoing the findings and conclusions of Goldstein et al [10] for counseling patient's postoperatively after regional anesthesia for ankle fractures, we believe that patients receiving a brachial plexus blockade can minimize their pain during the 12-to 24-hour postoperative period by preemptively taking oral pain medications 1 to 2 hours before the regional anesthesia begins to wane. This requires thorough counseling of patients and their family members during the 2 to 3 hours immediately after surgery.…”

Section: Discussionmentioning

confidence: 71%

“…In a prospective study of patients undergoing shoulder arthroscopy, rebound pain occurred 1 to 2 days postoperatively after interscalene block [20]. Goldstein et al [10], described a similar phenomenon related to ankle fracture fixation and popliteal blocks with an acute increase in pain at approximately 24 hours postoperatively. In our study, although operative time did not differ statistically (overall a mean of 5.5 additional minutes for the regional anesthesia group), the general anesthesia group had significantly longer PACU times and used significantly more pain medication in the PACU and cumulatively, a finding which is consistent with some previous studies [13,24].…”

Section: Discussionmentioning

confidence: 97%

“…A recent study has shed light on the phenomena of rebound pain associated with the resolution of regional anesthesia in the extremity [10]. Currently, surgeons do not know how best to counsel patients on the benefits of regional anesthesia versus general anesthesia for distal radius fracture fixation as the effects of rebound pain and immediate postoperative pain are not well documented for this surgical treatment [8].…”

Section: Discussionmentioning

confidence: 99%

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Does Brachial Plexus Blockade Result in Improved Pain Scores After Distal Radius Fracture Fixation? A Randomized Trial

Galos

Taormina

Crespo

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Distal radius fractures are very common injuries and surgical treatment for them can be painful. Achieving early pain control may help improve patient satisfaction and improve functional outcomes. Little is known about which anesthesia technique (general anesthesia versus brachial plexus blockade) is most beneficial for pain control after distal radius fixation which could significantly affect patients' postoperative course and experience. Questions/Purposes We asked: (1) Did patients receiving general anesthesia or brachial plexus blockade have worse pain scores at 2, 12, and 24 hours after surgery? (2) Was there a difference in operative suite time between patients who had general anesthesia or brachial plexus blockade, and was there a difference in recovery room time? (3) Did patients receiving general anesthesia or brachial plexus blockade have higher narcotic use after surgery? (4) Do patients receiving general anesthesia or brachial plexus blockade have higher functional assessment scores after distal radius fracture repair at 6 weeks and 12 weeks after surgery? Methods A randomized controlled study was performed between February, 2013 and April, 2014 at a multicenter metropolitan tertiary-care referral center. Patients who presented with acute closed distal radius fractures (Orthopaedic Trauma Association 23A-C) were potentially eligible for inclusion. During the study period, 40 patients with closed, displaced, and unstable distal radius fractures were identified as meeting inclusion criteria and offered enrollment and randomization. Three patients (7.5%), all with concomitant injuries, declined to participate at the time of randomization as did one additional patient (2.5%) who chose not to participate, leaving a final sample of 36 participants. There were no dropouts after randomization, and analyses were performed according to an intention-totreat model. Patients were randomly assigned to one of two groups, general anesthesia or brachial plexus blockade, and among the 36 patients included, 18 were randomized to each group. Medications administered in the postanesthesia care unit were recorded. Patients were discharged receiving oxycodone and acetaminophen 5/325 mg for pain control, and VAS forms were provided. Patients were called at predetermined intervals postoperatively (2 hours, 4 hours, 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours) to gather pain scores, using the VAS, and to document the doses of analgesics consumed. In addition, patients had regular followups at 2 weeks, 6 weeks, and 12 weeks. Pain scores were again recorded using the VAS at these visits.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Does Brachial Plexus Blockade Result in Improved Pain Scores After Distal Radius Fracture Fixation? A Randomized Trial

Galos

Taormina

Crespo

et al. 2016

Clinical Orthopaedics &Amp; Related Research

Self Cite

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“…Recent studies support this by indicating a positive effect on postoperative pain experience following neuraxial blockade or PNB in ankle surgery. [3][4][5] However, none of these studies investigated the opioid consumption for a full 24 hours postoperatively. Thus, they were unable to detect if the analgesic benefits of PNB are offset by rebound pain when the block subsides after 10-16 hours.…”

Section: Introductionmentioning

confidence: 97%

The Effects of Anesthetic Technique on Postoperative Opioid Consumption in Ankle Fracture Surgery

Christensen¹,

Møller²,

Nielsen³

et al. 2016

The Clinical Journal of Pain

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Scoping review of mode of anaesthesia in emergency surgery

Morley

Elliott

Rees

et al. 2020

British Journal of Surgery

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Background Emergency surgery encompasses more than 50 per cent of the surgical workload; however, research efforts are disproportionally low. The mode of anaesthesia used during emergency surgery may affect outcomes, but the extent of research and the impact of the different modes of anaesthesia used are unclear. Methods MEDLINE and Embase were searched using scoping review methodology with a rapid systematic search strategy, identifying any study comparing locoregional (local, nerve block, subarachnoid, epidural) anaesthesia with general anaesthesia. All studies describing outcomes of emergency surgery with differing modes of anaesthesia were identified. Excluded were: studies published before 2003, studies enrolling patients aged less than 18 years and studies using sedation only. Results Forty‐two studies were identified, describing 11 surgical procedures. Most publications were retrospective cohort studies (32). A very broad range of clinical and patient‐reported outcomes were described, with wide variation in the outcomes reported in different studies. Conclusion Reporting of mode of anaesthesia is inconsistent across different procedures and is often absent. There is a need for directed research efforts to improve the reporting standards of anaesthesia interventions, to understand the role of different modes of anaesthesia in specific emergency surgical procedures, and to standardize outcome reporting using core outcome sets.

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Efficacy of Popliteal Block in Postoperative Pain Control After Ankle Fracture Fixation

Cited by 84 publications

References 19 publications

Does Brachial Plexus Blockade Result in Improved Pain Scores After Distal Radius Fracture Fixation? A Randomized Trial

Does Brachial Plexus Blockade Result in Improved Pain Scores After Distal Radius Fracture Fixation? A Randomized Trial

The Effects of Anesthetic Technique on Postoperative Opioid Consumption in Ankle Fracture Surgery

Scoping review of mode of anaesthesia in emergency surgery

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