Sciatic nerve blockade improves early postoperative analgesia after open repair of calcaneus fractures

To determine the effectiveness of analgesia, with or without sciatic nerve blockade, after open repair of calcaneus fracture.

Randomized, prospective trial involving 30 patients divided into 3 groups of 10, all having open repair of calcaneus fractures. Group 1 used morphine patient-controlled analgesia alone. Groups 2 and 3 had morphine patient-controlled analgesia and a "one-shot" bupivacaine sciatic nerve blockade, either presurgically (group 2) or postsurgically (group 3).

Harborview Medical Center operating rooms and orthopedic floors.

Morphine use over 24 hours, visual analogue scale pain scores, and sciatic nerve blockade duration.

In the absence of sciatic nerve blockade, initial postoperative pain was marked, even with a mean recovery room dose of intravenous morphine more than 30 mg. Sciatic nerve blockade with bupivacaine had a mean duration of 14 hours and substantially reduced pain for the first 24 postoperative hours. Presurgical blockade confers no advantage over postsurgical blockade.

Sciatic nerve blockade confers significant benefit over morphine alone for analgesia after open repair of calcaneus fractures. Postsurgical sciatic nerve blockade provides the longest possible postoperative block duration.