Comparable Postoperative Pain Levels Using 2 Different Nerve Blocks in the Operative Treatment of Displaced Intra-articular Calcaneal Fractures

Siem A Dingemans, Kristian J de Ruiter, Merel F N Birnie, J Carel Goslings, Gan van Samkar, Tim Schepers, Siem A Dingemans, Kristian J de Ruiter, Merel F N Birnie, J Carel Goslings, Gan van Samkar, Tim Schepers

Abstract

Background: The aim of this study was to compare the postoperative pain levels in patients undergoing osteosynthesis of the calcaneus with either a popliteal nerve block or an ankle block.

Methods: A retrospective analysis of all consecutive patients undergoing operative fixation of a calcaneal fracture via a sinus tarsi approach between August 2012 and April 2017 in a single foot/ankle specialized center was performed. Single-shot popliteal blocks were placed using ultrasound guidance by an anesthesiologist while ankle blocks were placed by a foot/ankle specialized surgeon. Pain levels were measured through the numerical rating scale (NRS). In total, 83 patients were included in this study; 33 received a popliteal block, and 50 received an ankle block. No statistically significant differences were present in baseline characteristics between the 2 groups.

Results: Comparable postoperative pain levels were observed in both groups. There was no statistically significant difference in amount of morphine used between the 2 groups.

Conclusion: No differences were found in postoperative pain levels between patients receiving a single-shot popliteal block and patients who received a single-shot ankle block following calcaneal fracture surgery.

Level of evidence: III, comparative series.

Keywords: analgesia; ankle block; calcaneal; fracture; pain; popliteal block.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

References

    1. Chen KY, Chen L, Mao J. Buprenorphine-naloxone therapy in pain management. Anesthesiology. 2014;120(5):1262-1274.
    1. Cooper J, Benirschke S, Sangeorzan B, Bernards C, Edwards W. Sciatic nerve blockade improves early postoperative analgesia after open repair of calcaneus fractures. J Orthop Trauma. 2004;18(4):197-201.
    1. Dhukaram V, Kumar CS. Nerve blocks in foot and ankle surgery. Foot Ankle Surg. 2004;10(1):1-3.
    1. Ding DY, Manoli A, Galos DK, Jain S, Tejwani NC. Continuous popliteal sciatic nerve block versus single injection nerve block for ankle fracture surgery: a prospective randomized comparative trial. J Orthop Trauma. 2015;29(9):393-398.
    1. Elliot R, Pearce CJ, Seifert C, Calder JD. Continuous infusion versus single bolus popliteal block following major ankle and hindfoot surgery: a prospective, randomized trial. Foot Ankle Int. 2010;31(12):1043-1047.
    1. Falyar CR. Ultrasound-guided ankle blocks: a review of current practices. AANA J. 2015;83(5):357-364.
    1. Farrar JT, Berlin JA, Strom BL. Clinically important changes in acute pain outcome measures: a validation study. J Pain Symptom Manag. 2003;25(5):406-411.
    1. Goldstein RY, Montero N, Jain SK, Egol KA, Tejwani NC. Efficacy of popliteal block in postoperative pain control after ankle fracture fixation. J Orthop Trauma. 2012;26(10):557-561.
    1. Hadeed MM, Kandil A, Patel V, Morrison A, Novicoff WM, Yarboro S. Factors associated with patient-initiated telephone calls after orthopaedic trauma surgery. J Orthop Trauma. 2017;31(3):e96-e100.
    1. Hawker G, Mian S, Kendzerska T, French M. Measures of adult pain. Arthritis Care Res. 2011;63(11):240-252.
    1. Hunt KJ, Higgins TF, Carlston CV, Swenson JR, McEachern JE, Beals TC. Continuous peripheral nerve blockade as postoperative analgesia for open treatment of calcaneal fractures. J Orthop Trauma. 2010;24(3):148-155.
    1. Lee JS, Hobden E, Stiell IG, Wells GA. Clinically important change in the visual analog scale after adequate pain control. Acad Emerg Med. 2003;10(10):1128-1130.
    1. Li P, Stuart EA, Allison DB. Multiple imputation: a flexible tool for handling missing data. JAMA. 2015;314(18):1966-1967.
    1. McLeod DH, Wong DHW, Vaghadia H, Claridge RJ, Merrick PM. Lateral popliteal sciatic nerve block compared with ankle block for analgesia following foot surgery. Can J Anaesth. 1995;42(9):765-769.
    1. Migues A, Slullitel G, Vescovo A, Droblas F, Carrasco M, Turenne HP. Peripheral foot blockade versus popliteal fossa nerve block: a prospective randomized trial in 51 patients. J Foot Ankle Surg. 2005;44(5):354-357.
    1. Monsó A, Santaliestra J, Barbal F, Fitó F, Riudeubás J, Viladot R. Regional anaesthesia in foot surgery: peripheral blockade of the foot versus popliteal sciatic nerve block. Foot Ankle Surg. 2000;6(2):95-98.
    1. Ridderikhof ML, Lirk P, Schep NW, et al. The PanAM study: a multi-center, double-blinded, randomized, non-inferiority study of paracetamol versus non-steroidal anti-inflammatory drugs in treating acute musculoskeletal trauma. BMC Emerg Med. 2013;13:19.
    1. Rubin DB. Multiple Imputation for Nonresponse in Surveys. New York, NY: John Wiley; 1987.
    1. Schurman DJ. Ankle-block anesthesia for foot surgery. Anesthesiology. 1976;44(4):348-352.
    1. Singelyn FJ. Single-injection applications for foot and ankle surgery. Best Pract Res Clin Anaesthesiol. 2002;16(2):247-254.
    1. Vissers KCP, Besse K, Hans G, Devulder J, Morlion B. Opioid rotation in the management of chronic pain: where is the evidence? Pain Pract. 2010;10(2):85-93.

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