Efficacy of Hematoma Block After Intramedullary Rod Fixation of Femoral Shaft Fractures: A Prospective, Double-Blinded, Randomized Controlled Trial : Journal of Orthopaedic Trauma

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Original Article

Efficacy of Hematoma Block After Intramedullary Rod Fixation of Femoral Shaft Fractures: A Prospective, Double-Blinded, Randomized Controlled Trial

Yue, Ruixian Alexander MD; Shah, Nihar S. MD; Matar, Robert N. MD; Sagi, H Claude MD

Author Information
Journal of Orthopaedic Trauma 37(9):p 429-432, September 2023. | DOI: 10.1097/BOT.0000000000002623

Abstract

Objectives: 

To evaluate the efficacy of an intraoperative, postfixation 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: 

Eighty-two consecutive patients with isolated femoral shaft fractures (OTA/AO 32) underwent intramedullary rod fixation.

Intervention: 

Patients were randomized to receive an intraoperative, postfixation fracture hematoma injection containing 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 with 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.

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