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. 2025 Jul 28;13(8):e70713.
doi: 10.1002/ccr3.70713. eCollection 2025 Aug.

Peripheral Neuromodulation and Opioid Sparing Strategies for Mitigating Perioperative Pain in the Stabilization and Hardware Removal of Complex Trimalleolar Fractures: A Case Report

Bi Mo  1 , Sandra Sacks  1   2 , Jerry Markar  1
Affiliations

Peripheral Neuromodulation and Opioid Sparing Strategies for Mitigating Perioperative Pain in the Stabilization and Hardware Removal of Complex Trimalleolar Fractures: A Case Report

Bi Mo et al. Clin Case Rep. .

Abstract

Individualized opioid-free perioperative management, combining dual continuous peripheral nerve catheters targeting the popliteal sciatic and adductor canal nerves, non-opioid pharmacologic agents, and adjunctive neuromodulation, offers robust multimodal analgesia. This approach supports both ORIF and hardware removal in complex trimalleolar fractures while preserving function, reducing opioid-related risks, and promoting faster recovery.

Keywords: complex orthopedic fractures; hardware removal; opioid‐sparing strategies; perioperative pain management; peripheral neuromodulation; trimalleolar fractures.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
CT scan of the right lower extremity showing a trimalleolar fracture affecting the medial and posterior tibia and lateral fibula (yellow arrows). Image taken post‐manual reduction of ankle joint dislocation and plaster cast application in the emergency department.
FIGURE 2
FIGURE 2
Intraoperative fluoroscopy post‐initial ORIF stabilization. Anteroposterior and lateral views show extensive hardware placement and successful reduction of trimalleolar fractures.
See this image and copyright information in PMC

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