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

## TL;DR

This case report shows how combining nerve blocks and non-opioid methods can effectively manage pain during surgery for complex ankle fractures, reducing the need for opioids.

## Contribution

The paper introduces a novel opioid-sparing strategy using peripheral nerve catheters and neuromodulation for complex fracture surgeries.

## Key findings

- Dual nerve catheters provided effective pain control during surgery and hardware removal.
- The multimodal approach reduced opioid use and improved recovery outcomes.
- Functional preservation was achieved without opioid-related complications.

## 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.