SLR - October 2023 - Jiang
Title: A Comparative Analysis of Pain Control Methods after Ankle Fracture Surgery with a Peripheral Nerve Block: A Single-Center Randomized Controlled Prospective StudyReference: Lee JK, Lee GS, Kim SB, Kang C, Kim KS, Song JH. A Comparative Analysis of Pain Control Methods after Ankle Fracture Surgery with a Peripheral Nerve Block: A Single-Center Randomized Controlled Prospective Study. Medicina (Kaunas). 2023 Jul 14;59(7):1302. doi: 10.3390/medicina59071302. PMID: 37512113; PMCID: PMC10386082.
Level of evidence: Level I
Scientific Literature Review
Reviewed by: Jennifer Jiang, DPM
Residency program: Montefiore Medical Center – Bronx, NY
Podiatric relevance: Patients experience severe pain after surgical fixation of ankle fractures, which leads to significant anxiety and post-traumatic stress. Although their exact mechanism is unknown, dexamethasone and epinephrine increase the analgesic effect of anesthetics in peripheral nerve blocks. This study aimed to prospectively compare the postoperative pain control efficacy of peripheral nerve blocks with ropivacaine combined with dexamethasone/epinephrine and peripheral nerve blocks with only ropivacaine and added patient-controlled analgesia in patients with ankle fractures.
Methods: This is a single-centered double-blinded randomized controlled prospective study included patients aged 18–70 years surgically treated for unilateral ankle fractures between December 2021 and September 2022, all patients being treated by a single surgeon. Fracture types included fractures involving the articular surface of the distal tibia and fibula, including simple fibula fractures, bimalleolar fractures, trimalleolar fractures, and pilon fractures. The patients were divided into group A (n = 30), wherein pain was controlled using patient-controlled analgesia after lower extremity peripheral nerve block, and group B (n = 30), wherein dexamethasone/epinephrine was combined with the anesthetic solution during peripheral nerve block. In both groups, ropivacaine was used as the anesthetic solution for peripheral nerve block, and this peripheral nerve block was performed just before ankle surgery for the purpose of anesthesia for surgery. Pain (visual analog scale), patient satisfaction, and side effects were assessed and compared between the two groups for up to 60 hours postoperatively. All patients were discharged from hospital 3 days postoperatively.
Results: The patients’ demographic data were similar between groups. Pain scores were significantly lower in group B than in group A postoperatively. Satisfaction scores were significantly higher in group B. There were no anesthesia-related complications in either group.
Conclusions: The authors of this study conclude that dexamethasone and epinephrine as adjuvant anesthetic solutions can effectively control pain when performing surgery using peripheral nerve blocks for patients with ankle fractures. In foot and ankle surgery, postoperative pain control is a significant concern and the topic of much ongoing research. Conventionally, a combination of narcotics, non-steroidal anti-inflammatory drugs (NSAIDs), and acetaminophen is utilized to control postoperative pain. This study explores augmenting peripheral nerve block for immediate postoperative pain control within 60 hours after surgery, however it ignores mid- and long-term observations including potential complications and sequelae, which is a missed opportunity that warrants further research on this topic.