INTRODUCTION: Regional anesthesia is commonly used in place of, or in conjunction with, general anesthesia in elective, outpatient foot and ankle surgery. However, there is minimal data about its use in fracture care. This retrospective chart review evaluated the efficacy of popliteal fossa nerve blockade (PFNB) as an adjuvant to general anesthesia in ankle fracture surgery. METHODS: We reviewed the charts of patients who underwent open reduction and internal fixation for either bimalleolar or bimalleolar equivalent ankle fractures. Group I (24 patients) received general anesthesia alone and Group II (13 patients) received general anesthesia with PFNB. Variables included in analysis were patient's age, sex, injury pattern, ASA score, operative tourniquet time, block usage, daily pain scores, and post-operative narcotic usage. RESULTS: Patients who had general anesthesia plus PFNB had lower pain scores (mean of 5.6 vs. 7.3) and lower narcotic usage (mean of 41 mg morphine vs. 98mg) during the first hospital day. These differences were significant (p<0.005) and normalized by the second hospital day. DISCUSSION AND CONCLUSION: Popliteal fossa nerve block is a useful adjuvant to general anesthesia in ankle fracture patients. It delays the first usage of narcotics, decreases narcotic usage during the first day after surgery, and improves pain scores during the immediate postoperative period.