Continuous peripheral nerve blockade as postoperative analgesia for open treatment of calcaneal fractures.
OBJECTIVE
To examine the cost and efficacy of methods of general and regional anesthetic for postoperative pain control after open repair of intra-articular calcaneal fractures. We compared single-injection popliteal fossa blocks and continuous infusion popliteal fossa blocks with drug delivered through a catheter from an infusion pump (CPNB) to general or spinal anesthetic alone in terms of hospital charges, length of hospital stay, and postoperative oral and intravenous narcotic use, antiemetic use, and safety.


METHODS
Retrospective review.


METHODS
University Level I regional trauma center and associated orthopaedic surgery center.


METHODS
Charts were reviewed for all patients undergoing open treatment of calcaneal fractures during a 9-year period. One hundred six of 203 met study inclusion criteria.


METHODS
All patients received either general or spinal anesthetic. Patients additionally received preoperative single-injection popliteal fossa blocks, CPNB, or no regional block.


METHODS
Data were compared from each group for total hospital cost, length of stay, operating room times, narcotic use, postoperative nausea, and hospital readmission. Eighteen patients from the CPNB group who were discharged within 24 hours of surgery were examined in a subgroup analysis of ambulatory treatment.


RESULTS
There were no significant differences between the control group and the two regional anesthesia groups in total hospital cost, length of stay, narcotic use, or antiemetic use. However, subgroup analysis demonstrated that ambulatory CPNB patients had significantly lower total hospital costs and narcotic use compared with the remaining CPNB patients. There were no block-related complications. None of the short-stay patients required urgent medical attention or readmission after discharge.


CONCLUSIONS
CPNB through an infusion pump may allow patients undergoing open treatment of calcaneal fractures to be safely discharged within 24 hours with a concomitant decrease in healthcare costs. These data suggest that this method of postoperative pain management might be applied to other patients with major foot and ankle trauma and/or reconstructive procedures and that wider use of continuous peripheral nerve blocks may lead to a reduction in healthcare costs.
Hunt
Kenneth J
KJ
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT 84108, USA.
Higgins
Thomas F
TF
Carlston
Cory V
CV
Swenson
Jeffrey R
JR
McEachern
J Edward
JE
Beals
Timothy C
TC
D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D000932:Antiemetics / Q000191:economics / Q000627:therapeutic use; D002111:Calcaneus / Q000293:injuries*; D016022:Case-Control Studies; D005260:Female; D050723:Fractures, Bone / Q000503:physiopathology / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D009407:Nerve Block / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology; D011152:Popliteal Vein / Q000294:innervation / Q000502:physiology; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000209:etiology; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome
D000932:Antiemetics