ORIGINAL ARTICLE Continuous Peripheral Nerve Blockade as Postoperative Analgesia for Open Treatment of Calcaneal Fractures Kenneth J. Hunt, MD,* Thomas F. Higgins, MD,* Cory V. Carlston, MD,* Jeffrey R. Swenson, MD,*† J. Edward McEachern, MD,* and Timothy C. Beals, MD* Objective: To examine the cost and efficacy of methods of general and regional anesthetic for postoperative pain control after open repair of intra-articular calcaneal fractures. We compared single- injection popliteal fossa blocks and continuous infusion popliteal fossa blocks with drug delivered through a catheter from an infusion pump (CPNB) to general or spinal anesthetic alone in terms of hospital charges, length of hospital stay, and postoperative oral and intravenous narcotic use, antiemetic use, and safety. Design: Retrospective review. Setting: University Level I regional trauma center and associated orthopaedic surgery center. Patients/Participants: Charts were reviewed for all patients undergoing open treatment of calcaneal fractures during a 9-year period. One hundred six of 203 met study inclusion criteria. Intervention: All patients received either general or spinal anesthetic. Patients additionally received preoperative single- injection popliteal fossa blocks, CPNB, or no regional block. Outcome Measurements: Data were compared from each group for total hospital cost, length of stay, operating room times, narcotic use, postoperative nausea, and hospital readmission. Eighteen patients from the CPNB group who were discharged within 24 hours of surgery were examined in a subgroup analysis of ambulatory treatment. Results: There were no significant differences between the control group and the two regional anesthesia groups in total hospital cost, length of stay, narcotic use, or antiemetic use. However, subgroup analysis demonstrated that ambulatory CPNB patients had signifi- cantly lower total hospital costs and narcotic use compared with the remaining CPNB patients. There were no block-related complica- tions. None of the short-stay patients required urgent medical attention or readmission after discharge. Conclusions: CPNB through an infusion pump may allow patients undergoing open treatment of calcaneal fractures to be safely discharged within 24 hours with a concomitant decrease in healthcare costs. These data suggest that this method of postoperative pain management might be applied to other patients with major foot and ankle trauma and/or reconstructive procedures and that wider use of continuous peripheral nerve blocks may lead to a reduction in healthcare costs. Key Words: calcaneus fracture, regional anesthesia, cost analysis (J Orthop Trauma 2010;24:148–155) INTRODUCTION Open treatment of calcaneus fractures can result in significant postoperative pain. 1 The use of single-shot nerve blocks (SSNB) and continuous peripheral nerve block (CPNB) techniques have gained popularity as an adjunct to intra- operative and postoperative pain control in foot and ankle procedures as a result of improvements in injection techniques and simplified infusion systems. These types of peripheral nerve blocks may facilitate earlier hospital discharge, reduce postoperative pain and nausea, and perhaps reduce hospital costs. The issue of hospital charges is becoming increasingly important because rising healthcare costs are projected to present a major challenge for both private and governmental payers in the next several decades. 2 This concern has increased the need for orthopaedic providers to understand the economic impact of various therapies. 3,4 Orthopaedic providers attempt to control costs through various interventions, including shortening the period of postoperative hospitalization. 5,6 For example, retrospective analyses in total knee arthroplasty have demonstrated that CPNB is associated with shorter hospital stays and reduced hospital charges and costs without compromising patient outcomes or increasing morbidity. 6,7 Specialty-focused hospitals have shown superior outcomes with reduced total costs for knee and hip arthroplasty. 8 However, data are needed to determine the influence of peripheral nerve blocks on hospital costs in other orthopaedic subspecialties, including lower extremity trauma and foot and ankle reconstruction. The goal of this retrospective, case–control study is to compare the use of CPNB or SSNB with general or spinal anesthesia only in patients undergoing open treatment of intra- articular calcaneal fractures. Primary outcome variables include total hospital costs and length of hospital stay. Accepted for publication July 13, 2009. From the Departments of *Orthopaedic Surgery; and †Anesthesia, University of Utah, Salt Lake City, UT. The authors have no conflicts of interest as it relates to this study. No research support was received in support of this manuscript. Reprints: Timothy C. Beals, MD, University of Utah, Department of Orthopaedic Surgery, University Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108 (e-mail: Timothy.beals@hsc.utah.edu). Copyright Ó 2010 by Lippincott Williams & Wilkins 148 | www.jorthotrauma.com J Orthop Trauma  Volume 24, Number 3, March 2010