Peripheral nerve block in ankle fracture surgery: a qualitative study of patients’ experiences

• Published in: Anaesthesia 2018-01, Vol.73 (1), p.49-58
• Main Authors: Henningsen, M. J., Sort, R., Møller, A. M., Herling, S. F.
• Format: Article
• Language: English
• Subjects: Alertness; Anesthesia; Ankle; ankle fracture; Ethical standards; Ethics; Fractures; Ibuprofen; Informed consent; Morphine; Pain; Paracetamol; Patients; peripheral nerve block; postoperative pain; qualitative methodology; Qualitative research; Surgery
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.14088

Summary Peripheral nerve blocks are popular as a mode of anaesthesia for limb surgery and their beneficial effects are well documented in elective surgery. However, concerns have been raised about potential rebound pain outweighing the benefits in acute ankle fracture surgery. Furthermore, pain scores and morphine consumption do not provide a full picture, as pain is subjective. To evaluate the clinical usefulness of peripheral nerve blocks, we explored patients’ expectations and experiences by means of semi‐structured interviews analysed with systematic text condensation. We obtained ethical approval and informed consent and sampled purposively among adult patients scheduled for ankle surgery with nerve blocks as the primary mode of anaesthesia. Patients were interviewed within 48 h postoperatively. Data saturation was reached after 13 interviews. We found that, despite pre‐emptive ibuprofen and paracetamol, some patients did experience excruciating rebound pain for up to 2 h, although most had little or no pain. The patients had doubts about what to do when the block wore off, which led to a risk of unnecessary pain levels or morphine overuse. Patients had difficulty understanding the effect and course of the nerve blocks. They had misunderstandings regarding the blocks’ effect on sensation, resulting in fear of feeling pain during surgery and of permanent nerve damage after surgery. However, patients valued the mental alertness, ability to ambulate and efficient pain relief provided by the blocks. We recommend that patients be given thorough and repeated information as we feel this is crucial in preventing undesirable responses from patients, and is likely to increase the overall clinical usefulness of nerve blocks in acute limb surgery.