• Nabil Elkassabany, Lu Fan Cai, Samir Mehta, Jaimo Ahn, Lauren Pieczynski, Rosemary C Polomano, Stephanie Picon, Rosemary Hogg, and Jiabin Liu.
• Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA.
• J Orthop Trauma. 2015 Sep 1; 29 (9): 404-9.

ObjectivesTo 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).Study DesignProspective cohort study.SettingOrthopedic trauma service in an academic tertiary care center.PatientsNinety-three consecutive patients undergoing operative repair of fractures of the ankle and tibia.InterventionAdministration 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.OutcomesPatient 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).ResultsSatisfaction 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).ConclusionsPatient 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.Level Of EvidenceTherapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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