Local anesthetic infiltration before open reduction and internal fixation for ankle fracture: a single-blind randomized controlled study

Abstract

Background and objectives: Ankle fractures are painful. Intense uncontrolled postoperative pain may lead to persistent pain and complications. Local anesthetic infiltration into a surgical wound or joint blocks the pain at its origin, and thus it is particularly well-suited for ambulatory surgery. Several studies have shown a clear correlation between increased local and regional anesthesia use and the success of major knee and shoulder procedures in an ambulatory setting. The preferred indication for local infiltration is foot and ankle surgery, as it allows for earlier ambulation and reduces the risk of falls when compared to more extensive blocks of the lower limp. The purpose of this study was to investigate the preoperative use effects of local infiltration of ropivacaine or bupivacaine in pain management after open reduction and internal fixation treatment for ankle fracture. Methods: In this prospective single-blind randomized controlled trial, 93 patients (42 women and 51 men) were randomly divided into ropivacaine (spinal anesthesia + local anesthetic infiltration with 37.5 mg of 0.75% ropivacaine), bupivacaine (spinal anesthesia + local anesthetic infiltration with 25 mg of 0.5% bupivacaine) and control (spinal anesthesia only) groups. All patients underwent open reduction and internal fixation for acute ankle fracture and local anesthetic infiltration was applied before incision. Pain was evaluated using Visual Analog Scale scores at 4, 8, 12, and 24 hours after surgery. Results: Local anesthesia with ropivacaine was better in pain management with a lower Visual Analog Scale score at 4 hours after surgery than local anesthesia with bupivacaine and spinal anesthesia (P 0.05). Conclusions: Ropivacaine tends to have a rapider onset of action, longer acting effect, fewer complications, and lower motor block than bupivacaine in preoperative local anesthesia. Ethics and trial registration: This study protocol has been approved by the local ethics committee of IMSS in Mexico (approval No. R-2016-3401-55) and was registered with ClnicalTrials.gov (Identifier: NCT02949674) on October 31, 2016.