The purpose of this exploratory study is to characterize the postoperative pain profile of patients undergoing operation with internal fixation of an ankle fracture under nerve block anaesthesia. Special attention is payed towards the possible existence and clinical relevance of a rebound pain phenomenon upon cessation of the nerve block. Results are used to guide the set up of a randomized controlled trial on the subject.
Peripheral nerve blocks (PNB) are widely used as anaesthesia and postoperative pain control for surgery. Several studies have suggested multiple benefits of PNB's but primarily shown in elective surgery. Acute conditions like ankle fractures have a different pain profile and risks and benefits of PNB's have not been sufficiently researched in these cases. A recent study (Goldstein et al. 2012) suggested that a rebound pain effect occur upon cessation of PNB effect defined as a pain increase to a significantly higher level than observed in patients with no PNB at the same point after surgery. With this prospective, exploratory study we aim to examine the postoperative pain profile after PNB anaesthesia for ankle fracture surgery with focus on plausibility of a rebound pain effect (as defined above) upon PNB cessation. Secondarily to explore a variety of factors related to postoperative pain profile and feasibility of PNB anaesthesia for ankle surgery including efficacy, risk factors, time factors as well as postoperative recovery and overall patient satisfaction. Results will provide focus for a following randomized controlled trial.
Study Type
OBSERVATIONAL
Enrollment
21
Herlev Hospital
Herlev, Denmark, Denmark
Clinically relevant pain increase based on analysis of Numeric Rating Scale pain score (NRS) area under the curve (AUC) for the time period 12-24 hours compared to 0-12 hours postoperatively.
Pain scores are assessed and marked by the patient on a 0-10 numeric rating pain scale (NRS).
Time frame: 0, 2, 4, 6, 9, 12, 15, 18, 21 and 24 hours postoperatively
Opioid use 12-24 hours compared to 0-12 hours postoperatively
Rescue morphine doses are administered intravenously via a patient controlled analgesia (PCA) pump when needed. Times of use are electronically registered.
Time frame: 0-24 hours continuous measurement
Calculated Composite Score for the time intervals 0-24h, 0-12h and 12-24h postoperatively
We will calculate the "Silverman" composite score of opioid use and pain score combined. This in order to illustrate any increase in pain and to use for sample size calculations for a future randomised study on the subject.
Time frame: 0-24 hours postoperatively
Time to first opioid dose postoperatively
Time frame: 0-24 hours postoperatively
Time to patient estimated cessation of block effect
Time frame: 0-24 hours postoperatively
NRS day 1-7 as both "average" and "worst" of the day
NRS are filled out by the patient in a diary.
Time frame: Days 1-7 postoperatively
Daily opioid consumption day 1-7
Registered in a diary.
Time frame: Days 1-7 postoperatively
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