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

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.

The impact of lifestyle risk factors on the rate of infection after surgery for a fracture of the ankle.

AIMS: Lifestyle risk factors are thought to increase the risk of infection after acute orthopaedic surgery but the evidence is scarce. We aimed to investigate whether smoking, obesity and alcohol overuse are risk factors for the development of infections after surgery for a fracture of the ankle. PATIENTS AND METHODS: We retrospectively reviewed all patients who underwent internal fixation of a fracture of the ankle between 2008 and 2013. The primary outcome was the rate of deep infection and the secondary outcome was any surgical site infection (SSI). Associations with the risk factors and possible confounding variables were analysed univariably and multivariably with backwards elimination. RESULTS: A total of 1043 patients were included; 64 (6.1%) had a deep infection and 146 (14.0%) had SSI. Obesity was strongly associated with both outcomes (odds ratio (OR) 2.21, p = 0.017 and OR 1.68, p = 0.032) in all analyses. Alcohol overuse was similarly associated, though significant only in unadjusted analyses. Surprisingly, smoking did not yield statistically significant associations with infections. CONCLUSION: These findings suggest that obesity and possibly alcohol overuse are independent risk factors for the development of infection following surgery for a fracture of the ankle. This large study brings new evidence concerning these common risk factors; although prospective studies are needed to confirm causality. Cite this article: Bone Joint J 2017;99-B:225-30.

Translation and validation of the Danish version of the postoperative quality of recovery score QoR-15.

BACKGROUND: Patient perceived quality of recovery is an important outcome after surgery and should be measured in clinical trials. Quality of recovery after surgery and general anaesthesia can be measured by the QoR-15. A high score indicates a good recovery and the score ranges from 0 to 150. The aim of this study was to translate the QoR-15 questionnaire into Danish and do a full psychometric evaluation of the Danish version. METHODS: A translation and cultural adaption of the original version of the QoR-15 into a Danish version, the QoR-15D, was performed. After obtaining consent, patients undergoing elective abdominal, orthopaedic or gynaecological surgery under general anaesthesia were included. Patients completed the QoR-15D before surgery and on the first postoperative day. The validity, reliability, responsiveness and clinical feasibility of the QoR-15D were evaluated. RESULTS: One hundred and forty patients returned their pre- and postoperative questionnaire successfully giving a completion rate of 56%. The postoperative QoR-15 score was negatively correlated with duration of surgery (ρ = -0.21, 95% CI: -0.04 to -0.36, P < 0.02) and postoperative stay (ρ = -0.28, 95% CI: -0.12 to -0.43, P < 0.01). Postoperative QoR-15D scores were inversely related to the extent of surgery: minor, intermediate or major (127 ± 22, 106 ± 29 and 96 ± 24, respectively, P < 0.01). Cronbach's alpha and split-half reliability was 0.90 and 0.88. Test-retest reliability was 0.99 (95% CI: 0.94-1.00). Cohen's effect size was 1.13 and the standardized response mean was 0.82. CONCLUSION: The QoR-15D has preserved the validity, excellent reliability, high degree of responsiveness and the clinical feasibility of the original English version.