Comparison of continuous nerve block versus patient-controlled analgesia for postoperative pain and outcome after talar and calcaneal fractures.
Foot Ankle Int
; 35(11): 1116-21, 2014 Nov.
Article
em En
| MEDLINE
| ID: mdl-25116132
ABSTRACT
BACKGROUND:
Talar and calcaneal fractures and their treatment can cause severe postoperative pain. We hypothesized that a continuous peripheral nerve block (CPNB) would reduce pain scores more effectively than systemic analgesics, improve recovery, and lead to reduced length of stay (LOS).METHODS:
Over a 3-year period patients undergoing open reduction and internal fixation (ORIF) of a talar or calcaneal fracture were retrospectively analyzed. Patients received a CPNB catheter preoperatively or intravenous patient-controlled analgesia (PCA) postoperatively. Primary endpoint was Numerical Rating Scale (NRS) scores on postoperative day 1. Secondary endpoints were NRS scores up to day 3, opioid requirement, analgesia-related side effects, intraoperative blood loss, infection, and LOS. Eighty-seven patients were analyzed; 70 with calcaneal fracture, 21 with talar fracture, 4 with both. In all, 40 patients received CPNB, 47 patients PCA.RESULTS:
Median NRS scores on day 1 were 1.0 (IQR 3) in the CPNB group and 2.0 (IQR 3) in the PCA group (ns). Median LOS for patients with CPNB was 5 days (IQR3) and PCA 4 days (IQR 2 ns). Blood loss and incidence of local infections were comparable in both groups. Opioid requirement was significantly increased in the PCA group (P < .01).CONCLUSION:
Significant advantages or disadvantages were not seen in either group. However, the PCA group required about 30-fold more opioids compared to the CPNB group on day 1, although that did not lead to an increased number of side effects. LEVEL OF EVIDENCE Level III, retrospective comparative series.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Dor Pós-Operatória
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Calcâneo
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Tálus
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Analgesia Controlada pelo Paciente
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Traumatismos do Pé
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Fraturas Ósseas
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Fixação de Fratura
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Bloqueio Nervoso
Tipo de estudo:
Observational_studies
/
Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Foot Ankle Int
Assunto da revista:
ORTOPEDIA
Ano de publicação:
2014
Tipo de documento:
Article
País de afiliação:
Holanda