AAOS2017: Continuous vs. single-shot block for ankle & distal radius fractures

Study Type: Randomized Trial
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
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Synopsis
90 patients with either an ankle fracture (n=50) or distal radius fracture (n=40) undergoing surgical fixation were randomized to either a continuous block or single-shot block for analgesia. Cases of ankle fracture received a combined popliteal-sciatic nerve block, and cases of distal radius fracture received an infraclavicular block. Results demonstrated significant Please login to view the rest of this report. Please login to view the rest of this report.
Why was this study needed now?
Nerve blocks are often used for perioperative analgesia in orthopaedic surgery. Single-shot blocks have been traditionally employed in fracture fixation, though marked "rebound pain" has been described as the anesthesia wears offs. Continuous nerve blocks have been suggested as an alternative to single-shot blocks to increase the duration of analgesia, though their use requires technical skill for placement of a catheter, as well as additional monitoring. Therefore, a comparison of the efficacy of these treatments was needed.
What was the principal research question?
In the fixation of distal radius fractures and ankle fractures, is there any significant difference in analgesic efficacy between single-shot nerve blocks and continuous nerve blocks when assessed over the first 72 hours postoperatively?
Population: 90 patients with either ankle fracture (n=50) or distal radius fracture (n=40) scheduled for surgical fixation.
Intervention: Continuous nerve block group: Patients with an ankle fracture were administered a continuous popliteal-sciatic nerve block, and patients with a distal radius fracture were administered a continuous infraclavicular block. (n=41)
Comparison: Single-shot nerve block group: Patients with an ankle fracture were administered a single-shot popliteal-sciatic nerve block, and patients with a distal radius fracture were administered a single-shot infraclavicular block. (n=59)
Outcomes: Outcomes included pain scores and the number of analgesic pills consumed.
Methods: RCT
Time: Patients were assessed at 8, 12, 24, 48, and 72 hours postoperatively.
What were the important findings?
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How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.