Gi-Soo Lee, Chan Kang*, You Gun Won, Byung-Hak Oh, June-Bum Jun
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1 Comparison of Postoperative Pain Control Methods After Bony Surgery In the Foot And Ankle Gi-Soo Lee, Chan Kang*, You Gun Won, Byung-Hak Oh, June-Bum Jun Department of Orthopedic Surgery, College of Medicine, Konyang University, Daejeon, Korea *Department of Orthopedic Surgery, University of Medicine, Chung-Nam, Daejeon, Korea
2 Disclosure No Conflict to Disclore Gi-Soo Lee Chan Kang* You Gun Won Byung-Hak Oh June-Bum Jun Department of Orthopedic Surgery, College of Medicine, Konyang University, Daejeon, Korea *Department of Orthopedic Surgery, University of Medicine, Chung-Nam, Daejeon, Korea
3 Introduction Postoperative pain Relationship between Surgeon and Patient Severe pain after Bone surgery Purpose To evaluate Effectiveness of US-nerve block (analgesic effect) Comparison of between postoperative pain methods
4 Material and Method Prospective comparative study Between June 2014 and Sep 2015 All patients are operationed with preoperative Sciatic and Femoral US- Nerve block (Anesthesia) 0.75% Ropivacaine % lidocaine (40ml) Postop pain control (84 patients) Group A (n=30) : Fentanyl patch, 25mg immediately after the surgery Group B (n=27) : Additional Sciatic nerve block (0.2% Ropivacaine 30ml) at Op. night Group C (n=27) : Ketorolac [Tarasyn], 30mg I.M, Every 8h Injection
5 Material and Method Postoperative VAS score Postop 6, 12, 18, 24, 48hr Exclusion Criteria Psychotic history, history of drug abuse Incomplete VAS scoring for POD 48hrs A : B : C group (n) = 10 : 9 : 10 Statistical analysis SPSS software ver t-test and 1-way analysis of variance
6 Material and Method Patients demography Number of patients Group A Group B Group C Age (range) (19 62) (21 67) (20 79) Gender, Men Diagnosis Fracture ; 17 Deformity correct ; 6 Others ; 7 Fracture ; 21 Deformity correct ; 4 Others ; 5 Fracture ; 17 Deformity correct ; 7 Others ; 3
7 Material and Method Additional US- Sciatic nerve block method 0.2% Ropivacaine 30ml At OP night PM 8 ~10 O clock About 12 h after preoperative block `
8 Results Postoperative VAS score P<0.05 Postop. 6hrs 12hrs 18hrs 24hrs 48hrs Group A Group B Group C
9 Results Nerve block for operative anesthesia Average pain-free duration of 9.3 (range, ) h Kang C, KSSTA & Knee Surg Relat Res time sciatic nerve block (for analgesia) About 12h relieve severe pain during the acute phase Postop side effect Group A (n=5) ; nausea & vomiting Group B & C ; non-specific
10 Discussion US - guided nerve block Learning curve Visualized nerve & surroundings Nerve damage rate Block agents Successfulness of nerve block
11 Conclusion Postop pain control by Additional Sciatic nerve block Safe and Effectives Low Side effect Especially 1st OP night Surgeon-patient relationship Relieving severe pain during the first night (acute phase)
12 References 1. Gold BS, Kitz DS, Lecky JH, Neuhaus JM. Unanticipated admission to the hospital following ambulatory surgery. Jama. 1989;262(21): Giesa M, Jage J, Meurer A. [Post-operative pain management in orthopaedic surgery and traumatology]. Orthopade. 2006;35(2):211-20; quiz Kang C, Hwang DS, Kim YM, et al. Ultrasound-guided femorosciatic nerve block by orthopaedist for ankle fracture operation. Journal of Korean Foot and Ankle Society. 2010;14(1): Song JH, Kang C, Hwang DS, Hwang JM, Shin BK. Fentanyl Patches to Supplement Ultrasound-Guided Nerve Blocks for Improving Pain Control After Foot and Ankle Surgery: A Prospective Study. J Foot Ankle Surg. 2016;55(1): Kim YM, Joo YB, Kang C, Song JH. Can ultrasound-guided nerve block be a useful method of anesthesia for arthroscopic knee surgery? Knee Surg Sports Traumatol Arthrosc. 2015;23(7): Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg. 1997;85(4): Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth. 2002;89(3): Nett MP. Postoperative pain management. Orthopedics. 2010;33(9 Suppl): Ramsay MA. Acute postoperative pain management. Baylor University Medical Center. Proceedings: Baylor University Medical Center; Kehlet H. Modification of responses to surgery by neural blockade. Neural blockade. Philadelphia: Lippincott-Raven. 1998: Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94(1): Navas AM, Gutierrez TV, Moreno ME. Continuous peripheral nerve blockade in lower extremity surgery. Acta Anaesthesiol Scand. 2005;49(8):
Gi-Soo Lee, Chan Kang*, You Gun Won, Byung-Hak Oh, June-Bum Jun
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