• David Y Ding, Arthur Manoli, David K Galos, Sudheer Jain, and Nirmal C Tejwani.
• Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY.
• J Orthop Trauma. 2015 Sep 1; 29 (9): 393-8.

ObjectivesTo compare rebound pain and the need for narcotic analgesia after ankle fracture surgery for patients receiving perioperative analgesia through either a continuous infusion or a single injection nerve block.DesignProspective randomized controlled trial.SettingsSurgeries were performed at 2 hospitals affiliated with a large urban academic medical center.Patients/ParticipantsFifty patients undergoing operative fixation of an ankle fracture (AO/OTA type 44).InterventionParticipants were randomized to receive either a popliteal sciatic nerve block as a single shot (SSB group) or a continuous infusion through an On Q continuous infusion pump (On Q group).Main Outcome MeasurementsVisual analog scale and numeric rating scale (0-10) pain levels and amount of pain medication taken.ResultsFor all time points after discharge, mean postoperative pain scores and number of pain pills taken were lower in the On Q group versus the SSB group. Pain scores were significantly lower in the On Q group at the 12 hours postoperative time point (P = 0.002) and at 2 weeks postoperatively. The number of pain pills taken in the first 72 hours was lower in the On Q group (14.9 vs. 20.0; P = 0.036). Overall, 7/23 patients in the On Q group had their pump malfunction and 1 patient accidently removed the catheter.ConclusionsUse of continuously infused regional anesthetic for pain control in ankle fracture surgery significantly reduces "rebound pain" and the need for oral opioid analgesia compared with single-shot regional anesthetic.Level Of EvidenceTherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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