Comparison of postoperative pain control methods after bony surgery in the foot and ankle

Background

We performed a prospective study to evaluate and compare the effectiveness of postoperative pain control methods after bone surgery in the foot and ankle.

Methods

Among the patients who underwent foot and ankle surgery from June 2014 to September 2015 with an ultrasound-guided nerve block, 84 patients who fully completed a postoperative pain survey were enrolled. An opioid patch (fentanyl patch, 25 mg) was applied in group A (30 patients). Diluted anesthetic (0.2% ropivacaine, 30 ml) was injected into the sciatic nerve once, about 12 h after the preoperative nerve block, in group B (27 patients). Periodic intramuscular injection of an analgesic (ketorolac [Tarasyn], 30 mg) was performed in group C (27 patients). The visual analogue scale (VAS) pain scores at 6, 12, 18, 24, and 48 h after surgery were checked, and the complications of all methods were monitored.

Results

The mean VAS pain score was lower in group B, with a statistically significant difference (P < .05) between groups A, B, and C at 12 and 18 h after surgery. Four patients in group A experienced nausea and vomiting; however, no other patients complained of any complications or adverse effects.

Conclusion

The ultrasound-guided injection of a diluted anesthetic into the sciatic nerve seemed to be the most useful method for controlling pain in the acute phase after bone surgery in the foot and ankle. The injection of the diluted anesthetic once on the evening of the day of surgery resulted in less postoperative pain in the patients.

Level of evidence

II.