Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT 84108, USA.
J Orthop Trauma. 2010 Mar;24(3):148-55. doi: 10.1097/BOT.0b013e3181bfc9f7.
To 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.
Retrospective review.
University Level I regional trauma center and associated orthopaedic surgery center.
PATIENTS/PARTICIPANTS: Charts 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.
All patients received either general or spinal anesthetic. Patients additionally received preoperative single-injection popliteal fossa blocks, CPNB, or no regional block.
Data 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.
There 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.
CPNB 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.
探讨跟骨关节内骨折切开复位术后应用全身和局部麻醉控制疼痛的成本-效果比。我们将单次腘窝阻滞和连续腘窝阻滞（通过输注泵经导管给药）与单纯全身麻醉或椎管内麻醉进行比较，比较指标包括住院费用、住院时间、术后口服和静脉阿片类药物使用、止吐药使用以及安全性。
回顾性研究。
大学一级区域性创伤中心和相关骨科治疗中心。
患者/参与者：对 9 年内接受切开复位治疗的跟骨骨折患者的病历进行了回顾。203 例患者中 106 例符合研究纳入标准。
所有患者均接受全身或椎管内麻醉。患者另外接受术前单次腘窝阻滞、连续腘窝阻滞（CPNB）或不接受区域阻滞。
对每组患者的总住院费用、住院时间、手术时间、阿片类药物使用、术后恶心和住院再入院情况进行比较。CPNB 组中有 18 例患者术后 24 小时内出院，对这部分患者进行了亚组分析。
与对照组和两组局部麻醉组相比，CPNB 组患者的总住院费用、住院时间、阿片类药物使用或止吐药使用无显著差异。然而，亚组分析显示，与其余 CPNB 患者相比，门诊 CPNB 患者的总住院费用和阿片类药物使用明显降低。未发生与阻滞相关的并发症。所有短期住院患者出院后均无需紧急医疗处理或再次入院。
通过输注泵行 CPNB 可能使接受切开复位治疗的跟骨骨折患者安全出院，且住院费用降低。这些数据表明，这种术后疼痛管理方法可能适用于其他足部和踝关节创伤和/或重建手术的患者，广泛应用连续外周神经阻滞可能会降低医疗费用。
