title: Comparison of continuous nerve block versus patient-controlled analgesia for postoperative pain and outcome after talar and calcaneal fractures.
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).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level III, retrospective comparative series.
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Willem E
authors.initials: WE
authors.lastname: Luiten
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Schepers
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Jan S
authors.initials: JS
authors.lastname: Luitse
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hermanides
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Amsterdam, Netherlands m.f.stevens@amc.uva.nl.
authors.forename: Markus F
authors.initials: MF
authors.lastname: Stevens
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Hollmann
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Gan
authors.initials: G
authors.lastname: van Samkar
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D002111:Calcaneus / Q000293:injuries*; D005260:Female; D018409:Foot Injuries / Q000601:surgery*; D005592:Fracture Fixation / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D013628:Talus / Q000293:injuries*; D016896:Treatment Outcome
keywords: CPNB; PCA; calcaneus; fracture; talus