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
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
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
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 + 0.2 % 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
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. 19.0 t-test and 1-way analysis of variance
Material and Method Patients demography Number of patients Group A Group B Group C 30 27 27 Age (range) 50.85 (19 62) 47.30 (21 67) 46.38 (20 79) Gender, Men 17 15 16 Diagnosis Fracture ; 17 Deformity correct ; 6 Others ; 7 Fracture ; 21 Deformity correct ; 4 Others ; 5 Fracture ; 17 Deformity correct ; 7 Others ; 3
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 `
Results Postoperative VAS score 8 7 6 5 4 3 2 1 0 P<0.05 Postop. 6hrs 12hrs 18hrs 24hrs 48hrs Group A Group B Group C
Results Nerve block for operative anesthesia Average pain-free duration of 9.3 (range, 6.8 11.2) h Kang C, KSSTA & Knee Surg Relat Res. 2015 1-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
Discussion US - guided nerve block Learning curve Visualized nerve & surroundings Nerve damage rate Block agents Successfulness of nerve block
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)
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