title: Does Regional Anesthesia Improve the Quality of Postoperative Pain Management and the Quality of Recovery in Patients Undergoing Operative Repair of Tibia and Ankle Fractures?
abstract: OBJECTIVE
  To determine whether the use of peripheral nerve blocks (PNBs) as part of an analgesic protocol for operative repair of tibia and ankle fractures can improve the quality of postoperative pain management and the quality of recovery (QOR).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Orthopedic trauma service in an academic tertiary care center.
  
  
  METHODS
  Ninety-three consecutive patients undergoing operative repair of fractures of the ankle and tibia.
  
  
  METHODS
  Administration of popliteal and saphenous nerve blocks, as part of postoperative analgesia regimen in some patients. Patients were labeled as the regional group or the no-regional group based on whether they received PNBs.
  
  
  RESULTS
  Patient satisfaction and the quality of pain management were measured 24 hours after surgery using the Revised American Pain Society Patient Outcome Questionnaire. The QOR was measured at 24 and 48 hours after surgery using the short version of the Quality of Recovery Questionnaire (QOR-9).
  
  
  RESULTS
  Satisfaction with pain management was significantly higher (P = 0.005) in the regional group when compared with the no-regional group. Average pain scores over 24 hours was similar between the 2 groups (P = 0.07). The regional group reported less time spent in severe pain over 24-hour period (40 vs. 50%, P = 0.04) and higher overall perception of pain relief (80 vs. 65%, P = 0.003). Patients receiving regional anesthesia also demonstrated better QOR measured by the QOR-9 at 24 hours (P = 0.04) but not at 48 hours (p = 0.11).
  
  
  CONCLUSIONS
  Patient satisfaction and the quality of postoperative pain management for the first 24 hours were better in patients who received PNBs as part of their postoperative analgesic regimen when compared with patients who received only systemic analgesia.
  
  
  METHODS
  Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA.
authors.forename: Nabil
authors.initials: N
authors.lastname: Elkassabany
authors.forename: Lu Fan
authors.initials: LF
authors.lastname: Cai
authors.forename: Samir
authors.initials: S
authors.lastname: Mehta
authors.forename: Jaimo
authors.initials: J
authors.lastname: Ahn
authors.forename: Lauren
authors.initials: L
authors.lastname: Pieczynski
authors.forename: Rosemary C
authors.initials: RC
authors.lastname: Polomano
authors.forename: Stephanie
authors.initials: S
authors.lastname: Picon
authors.forename: Rosemary
authors.initials: R
authors.lastname: Hogg
authors.forename: Jiabin
authors.initials: J
authors.lastname: Liu
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage*; D064386:Ankle Fractures / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D017060:Patient Satisfaction; D020127:Recovery of Function / Q000187:drug effects; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local