Objectives:
To evaluate the efficacy of an intraoperative, post-fixation fracture hematoma block on postoperative pain control and opioid consumption in patients with acute femoral shaft fractures.
Design:
Prospective, double-blinded, randomized controlled trial.
Setting:
Academic Level I Trauma Center.
Patients/Participants: 82 consecutive patients with isolated femoral shaft fractures (OTA/AO 32) underwent intramedullary rod fixation.
Intervention:
Patients were randomized to receive an intraoperative, post-fixation fracture hematoma injection containing either 20 mL of normal saline or 0.5% ropivacaine in addition to a standardized multimodal pain regimen that included opioids.
Main Outcome Measurements:
Visual analog scale (VAS) pain scores and opioid consumption.
Results:
The treatment group demonstrated significantly lower VAS pain scores than the control group in the first 24-hour postoperative period (5.0 vs 6.7, p=0.004), 0-8 hours (5.4 vs 7.0, p=0.013), 8-16 hours (4.9 vs 6.6, p=0.018), and 16-24 hours (4.7 vs 6.6, p=0.010) postoperatively. In addition, the opioid consumption (morphine milligram equivalents) was significantly lower in the treatment group compared to the control group over the first 24-hour postoperative period (43.6 vs 65.9, p=0.008). No adverse effects were observed secondary to the saline or ropivacaine infiltration.
Conclusions:
Infiltrating the fracture hematoma with ropivacaine in adult femoral shaft fractures reduced postoperative pain and opioid consumption compared with saline control. This intervention presents a useful adjunct to multimodal analgesia to improve postoperative care in orthopaedic trauma patients.
Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
