The Impact of Peripheral Nerve Block on the Quality of Care After Ankle Fracture Surgery: A Quality Improvement Study.

Objectives: To increase peripheral nerve block (PNB) administration for ankle fracture surgeries (AFSs) at our institution to above 50% by January 1st, 2021.

Design: Longitudinal, single-center quality improvement study conducted at a high-volume tertiary care center.

Patients: All patients undergoing isolated AFS for unimalleolar, bimalleolar, or trimalleolar ankle fracture from July 2017 to April 2021 were included in this study.

Intervention: Interventions implemented to minimize barriers for PNB administration included recruitment and training of expert anesthesiologists in regional anesthesia, procurement of ultrasound machines, implementation of a dedicated block room, and creation of a pamphlet for patients describing multimodal analgesia.

Main Outcome Measurement: The primary outcome was the percentage of patients receiving PNB for AFS. Secondary outcomes included hospital length-of-stay, postanesthesia care unit (PACU) and 24-hour postoperative opioid consumption (mean oral morphine equivalent [OME]), proportion of patients not requiring opioid analgesic in PACU, and PACU and 24-hour postoperative nausea/vomiting requiring antiemetic.

Results: The PNB and non-PNB groups included 78 and 157 patients, respectively. PNB administration increased from <5% to 53% after implementation of the improvement bundle. Mean PACU and 24-hour opioid analgesic consumption was lower in the PNB group (PACU OME 38.96 mg vs. 55.42 mg, P = 0.001; 24-hour OME 50.83 mg vs. 65.69 mg, P = 0.008). A greater proportion of patients in the PNB group did not require PACU opioids (62.8% vs. 27.4%, P < 0.001).

Conclusions: By performing a root cause analysis and implementing a multidisciplinary, patient-centered improvement bundle, we increased PNB administration for AFSs, resulting in reduced postoperative opioid analgesia consumption.

Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.