Comparative Outcomes of Postoperative Pain between a Popliteal Sciatic Nerve Blockade or Local Morphine and Ketorolac Injection Adjuvant to a Spinal Blockade in Ankle Fracture Surgery: A Randomized Controlled Trial
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Abstract
BACKGROUND: The management of postoperative pain after ankle fracture surgery is crucial for patient recovery. Opioid use, while effective, can lead to undesirable side effects. This comparative study aims to identify more effective pain control methods that reduce opioid consumption.
OBJECTIVE: To compare pain reduction and hospital stay duration among patients with ankle fractures who received spinal anesthesia combined with popliteal block versus those who received subcutaneous analgesic injections.
METHOD: A randomized controlled trial involving 76 patients with bimalleolar ankle fractures was conducted. The patients were divided into two groups comprising a popliteal block group (n=38) and a subcutaneous injection group (n=38). Pain was assessed using the Visual Analogue Scale (VAS), and the duration of hospital stay, opioid usage, and Foot and Ankle Ability Measure (FAAM) at 6 months were evaluated. Multi-level regression analysis was used to assess trends in pain reduction over time.
RESULTS: The subcutaneous injection group experienced significantly less pain at 24 and 48 hours post-surgery (p<0.001), a shorter hospital stay (61.9 hours vs. 66 hours, p=0.007), and a shorter time to incision (16.8 minutes vs. 30.9 minutes, p<0.001). Multi-level regression analysis indicated a trend toward greater pain reduction in the subcutaneous group (-0.29 units per visit, p=0.06), though not statistically significant. No significant difference was observed in opioid consumption or FAAM at 6 months between the groups.
CONCLUSION: Subcutaneous analgesic injections combined with spinal anesthesia provide better postoperative pain relief, reduce preoperative preparation time, and shorten the duration of hospital stay compared to popliteal block, without increasing complications. While regression analysis suggests a promising trend in pain reduction, larger sample sizes in future studies may confirm clinically significant outcomes.
Thaiclinicaltrials.org number, TCTR20240924001
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