Efficacy of perifracture site injections for pain control following distal radius and ankle fracture surgery: a meta-analysis of randomized controlled trials

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Abstract

BACKGROUND: Surgical site analgesic injections are used as part of multimodal analgesia in elective orthopedic surgery, but their effectiveness in orthopedic trauma surgery, particularly for distal extremity fractures, remains controversial. This meta-analysis aimed to assess the efficacy of peri-fracture site local analgesic injections on postoperative pain and opioid consumption after distal radius and ankle fracture surgery. METHODS: A comprehensive search of PubMed, the Cochrane Library, and EMBASE was performed to identify randomized controlled trials assessing the efficacy of perifracture site injections for pain control after distal extremity fracture surgery. Pooled analyses compared postoperative pain intensity and total opioid consumption between the injection and control groups. RESULTS: Five randomized controlled trials comprising 390 participants were included. The pooled analysis showed that the injection group had significantly lower pain scores at 4 h postoperatively (SMD - 0.34; 95% CI - 0.56 to - 0.12; I2 = 37%). However, no significant differences in pain scores were observed between 8 and 48 h, with substantial heterogeneity at 8 and 24 h (8 h: SMD - 0.18; 95% CI - 0.78 to 0.42, I2 = 86%; 24 h: SMD - 0.23; 95% CI - 0.81 to 0.35, I2 = 85%). Total opioid consumption was significantly lower in the injection group (SMD - 0.29; 95% CI - 0.52 to - 0.07; I2 = 6%). CONCLUSIONS: Peri-fracture site injection for distal radius and ankle fractures provided significant analgesic efficacy confined to the early postoperative period, along with an overall reduction in opioid consumption. Further investigations are needed to establish optimal injection protocols and to determine whether this approach can provide more sustained postoperative pain relief. Registry number: CRD420251185330.

Abstract as published, via PubMed.