• Kenneth J Hunt, Thomas F Higgins, Cory V Carlston, Jeffrey R Swenson, J Edward McEachern, and Timothy C Beals.
• Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT 84108, USA.
• J Orthop Trauma. 2010 Mar 1;24(3):148-55.

ObjectiveTo 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.DesignRetrospective review.SettingUniversity Level I regional trauma center and associated orthopaedic surgery center.Patients/ParticipantsCharts 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.InterventionAll patients received either general or spinal anesthetic. Patients additionally received preoperative single-injection popliteal fossa blocks, CPNB, or no regional block.Outcome MeasurementsData 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.ResultsThere 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.ConclusionsCPNB 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.

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