Single Shot Versus OnQ Pump in Extremity Fractures
Condition: Pain; Fracture
MeSH terms: Fractures, Bone
Intervention: Ankle SSB; Ankle OnQ; DR SSB; DR OnQ
Intervention description: general anesthesia/sedation with a single shot; Primary predictor variable: single shot block, a 22 gauge, 3.5 inch needle will be used and 20cc of 2% lidocaine with 1:200,000 epinephrine + 20cc of 0.5% bupivacaine with 1:300,000 epinephrine will be injected around the nerve after confirming negative aspiration every 5 cc.; versus regional block with continuous infusion using an OnQ pump. 17 gauge Tuohy needle will be used and 20cc of 2% lidocaine with epinephrine +20cc of 0.5% bupivacaine with1:300,000epinephrine will be injected around the nerve after confirming negative aspiration every 5cc.; general anesthesia/sedationwith a single shot; general anesthesia/sedation with a single shot; Primary predictor variable: single shot block, a 22 gauge, 3.5 inch needle will be used and 20cc of 2% lidocaine with 1:200,000 epinephrine + 20cc of 0.5% bupivacaine with 1:300,000 epinephrine will be injected around the nerve after confirming negative aspiration every 5 cc.; versus regional block with continuous infusion using an OnQ pump. 17 gauge Tuohy needle will be used and 20cc of 2% lidocaine with epinephrine +20cc of 0.5% bupivacaine with1:300,000epinephrine will be injected around the nerve after confirming negative aspiration every 5cc.
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 100.0
Sex: All
Minimum age: 18 Years
Maximum age: 90 Years
Healthy volunteers: No

Summary:

      Peripheral nerve blocks have been well studied in the literature with generally good results
      for controlling post operative pain following orthopaedic surgery. Regional anesthesia has
      many benefits. It provides excellent intraoperative anesthesia and muscle relaxation as well
      as analgesia that continues into the post-operative period. These regional blocks are also
      effective in controlling pain in the immediate post-operative period. However, as the block
      wears off, patients begin experiencing increased pain. Compared to patients treated without
      regional blocks, these patients will often experience a "rebound pain"--pain occurring 12-24
      hours after surgery that is subjectively worse than that in patients treated without regional
      blocks. Therefore, the investigators propose to use a continuous infusion of anesthetic in
      order to provide sustained pain control post-operatively. Preoperatively, patients will be
      randomized into a single shot peripheral nerve block versus a continuous infusion of
      peripheral nerve block. Post-operatively, pain will be assessed using the Visual Analogue
      Scale (1-100) prior to being discharged from PACU. Time to discharge and amount of pain
      medication taken will be recorded. Patients will be contacted at certain time intervals
      postoperatively to assess their pain scale and pain medication intake. Patients will be seen
      for routine post-operative follow-up visits where they will be assessed for satisfaction,
      pain, residual neurological symptoms, and signs of infection.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Patients at least 18 years old.

          2. Male or Female

          3. All racial and ethnic groups

          4. Fractures and fracture/dislocations of the foot, ankle, tibia, fibula, elbow, forearm,
             wrist and hand

          5. Patients who opt for surgical treatment of their fractures.

          6. Patients who consent to be randomized.

          7. Patients who are willing to follow-up for a minimum of 52 weeks.

        Exclusion Criteria:

          1. Patients younger than 18 years old.

          2. Patients who are on chronic opioids

          3. Patients who abuse opioids

          4. Patients who are unwilling to follow-up for a minimum of 52 weeks.

          5. Neurologic condition that could interfere with pain sensation