Inclusion criteria were as follows: patients between the ages of 18 to 65 years, with a CPT code of 27766, 2269, 27792, 27814, 27822, and/or 27823, and with the procedure performed by an orthopedic or podiatric surgeon. The electronic medical records were then retrospectively interrogated for study selection criteria. 5 The specific codes used in this search were as follows: 27766 (open treatment of medial malleolus fracture, includes internal fixation), 27769 (open treatment of posterior malleolar fracture, includes internal fixation), 27792 (open treatment of distal fibula fracture, includes internal fixation), 27814 (open treatment of bimalleolar ankle fracture, includes internal fixation), 27822 (open treatment of trimalleolar ankle fracture, includes internal fixation when performed, medial and/or lateral with fixation of posterior lip), and 27823 (open treatment of trimalleolar ankle fracture, includes internal fixation when performed, medial and/or lateral malleolus, with fixation of posterior lip) (Table (Table1 1). We hypothesize that patients with administration of peripheral nerve blocks will have decreased postoperative pain scores as compared to those without peripheral nerve blocks in the setting of closed ankle ORIF.Īfter approval from our institutional review board, a Current Procedural Terminology (CPT) code search was performed of all patients within our institution over a 3-year data collection period (August 2016–June 2019). Given these considerations, the objective of this investigation was to evaluate the effect of preoperative peripheral nerve blockade on pain outcomes after ankle fracture surgery. 2, 12, 14, 21, 25 Patients having orthopedic surgeries are at risk for becoming addicted to opioids, and one benefit of peripheral nerve blocks might be to provide an alternative mode of pain control. Peripheral nerve blocks offer one option to provide good pain relief and decrease the number of narcotics used in the postoperative setting for patients undergoing osseous orthopedic procedures, and specifically foot and ankle surgery. With the existing risk to patients of continued opioid use beyond the postoperative period, alternative methods of pain control must be used. 24 specifically looked at foot and ankle orthopedic surgery and concluded that anesthesia type, patient age less than 60, preoperative visual analog scale score of greater than 6, and osseous-based procedures were independent factors associated with opioid consumption. 4, 15 Publications have discussed “over prescription of narcotics” when it comes to lower extremity surgery such as ORIF. 15 Many patients with displaced ankle fractures will require surgical open reduction internal fixation (ORIF), and typically, patients will be prescribed narcotics postoperatively for pain control. 3, 14, 16, 18, 22, 23, 29Ĭlosed ankle fractures are a common orthopedic problem that can present either in the emergency department setting or outpatient clinic. 8, 11, 17, 20 Among prescribers, orthopedic surgeons ranked the third highest in writing for opioids in 2009 after primary care physicians and internists. 6, 27 A substantial number of postsurgical patients subsequently become addicted to prescription narcotics, with approximately 2 million people in the United States addicted to prescription opioids and approximately 530 deaths occurring weekly because of opioid overdose. Opioids are commonly prescribed to reduce postoperative pain.
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