Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
J Bone Joint Surg Am. 2019 Dec 18;101(24):2194-2202. doi: 10.2106/JBJS.19.00293.
Pain management following surgical treatment of an ankle fracture is an under-studied area of clinical practice. The present study evaluated the efficacy of a multimodal surgical-site injection as an adjunct to postoperative pain management in patients with an operatively treated, closed, rotational ankle fracture.
Patients indicated for operative fixation of a rotational ankle fracture were randomized to receive multimodal surgical-site injection (ropivacaine 200 mg, epinephrine 0.6 mg, and morphine 5 mg) or no injection (control). Visual analog scale (VAS) pain and opioid consumption data were collected every 4 hours until discharge from the hospital. Length of stay and discharge destination were recorded. Patients were sent automated text messages to report VAS pain and opioid usage during the first 2 weeks after discharge.
One hundred patients (49 injection and 51 control) were enrolled. Demographic data were similar between the 2 groups. Mean VAS scores over the first 24 and 48 hours postoperatively were slightly lower in the injection group (42 ± 3 and 41 ± 3, respectively) compared with the control group (52 ± 3 and 50 ± 3, respectively; p = 0.01 and p < 0.01, respectively). The median opioid usage, in terms of morphine equivalent dose, was similar over the first 24 hours between the injection group (25.5; range, 0 to 74.7) and the control group (28.3; range, 2.5 to 91.0; p = 0.35). The median opioid usage from recovery room admission to discharge was also similar between the injection group (29.0; range, 0 to 85.3) and the control group (32.7; range, 4.3 to 215.0; p = 0.35). There were no differences in outpatient VAS scores or opioid consumption during the first 2 weeks postoperatively as assessed with use of automated text messaging. Median length of stay was 22.3 hours (range, 1.7 to 182.3 hours) for the injection group and 22.5 hours (range, 2.2 to 123.3 hours) for the control group (p = 0.71). The response rate for the post-discharge automated text messages was 85.1%. Complication rates were similar.
The use of multimodal surgical-site injections in operatively treated rotational ankle fractures is associated with a reduction in immediate in-hospital pain scores that is statistically significant but below the minimal clinically important difference.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
踝关节骨折手术后的疼痛管理是临床实践中研究不足的领域。本研究评估了多模式手术部位注射作为接受手术治疗的闭合性、旋转性踝关节骨折患者术后疼痛管理辅助治疗的疗效。
接受手术固定旋转性踝关节骨折的患者随机分为接受多模式手术部位注射（罗哌卡因 200mg、肾上腺素 0.6mg 和吗啡 5mg）或不注射（对照组）。每 4 小时收集视觉模拟量表（VAS）疼痛和阿片类药物使用数据，直至出院。记录住院时间和出院去向。患者在出院后第 1 和第 2 周通过自动短信报告 VAS 疼痛和阿片类药物使用情况。
共纳入 100 例患者（49 例注射组和 51 例对照组）。两组患者的人口统计学数据相似。与对照组相比（分别为 52±3 和 50±3），注射组术后前 24 和 48 小时的 VAS 评分略低（分别为 42±3 和 41±3；p=0.01 和 p<0.01）。在术后前 24 小时，注射组的吗啡等效剂量阿片类药物使用中位数相似（25.5；范围 0 至 74.7）与对照组（28.3；范围 2.5 至 91.0；p=0.35）。从恢复室入院到出院的阿片类药物使用中位数也相似，注射组（29.0；范围 0 至 85.3）和对照组（32.7；范围 4.3 至 215.0；p=0.35）。使用自动短信评估，术后前 2 周门诊 VAS 评分或阿片类药物使用无差异。注射组的中位住院时间为 22.3 小时（范围 1.7 至 182.3 小时），对照组为 22.5 小时（范围 2.2 至 123.3 小时）（p=0.71）。术后自动短信回复率为 85.1%。并发症发生率相似。
在手术治疗的旋转性踝关节骨折中使用多模式手术部位注射与立即住院疼痛评分降低相关，统计学上有显著意义，但低于最小临床重要差异。
治疗水平 I。有关证据水平的完整描述，请参见作者说明。
