Preoperative Opioid Use Results in Greater Postoperative Opioid Consumption After Thumb Basal Joint Arthroplasty

Purpose Currently no guidelines exist for the timing of the injection of anesthetics in surgeries performed under general anesthesia to minimize postoperative pain. To better understand the role of timing of the injection of local anesthesia in hand surgery performed under general anesthesia, we evaluated the effect of pre- versus postincisional local analgesic injection on immediate postoperative pain experience. We hypothesize that the preincisional (preemptive) injection will result in decreased immediate postoperative pain experience and analgesic use when compared with postincisional injection. Methods Consecutive cases of thumb basal joint arthroplasty performed over a 4-year period were retrospectively reviewed. During the first half of the study period, the surgical site was infiltrated with 0.5% bupivacaine at the completion of surgery following closure. During the second half of the study period, the surgical site was infiltrated with 0.5% bupivacaine prior to skin incision. Data collected included patient demographics, immediate postoperative recovery room (PACU) pain scores, and postoperative opioid consumption in morphine equivalents. Results Two-tailed t-test identified no significant difference between the pre- and postincision cohorts relative to PACU entrance pain scores and time spent in the PACU. PACU exit pain scores were significantly lower in the preincision cohort. The mean PACU pain score was also significantly lower in the preincision cohort. PACU opioid consumption, converted into morphine equivalents, was found to be 211 mg in the preincision versus 299 mg in the postincision cohort. Conclusion The preincisional (preemptive) injection of local anesthesia was found to result in lower pain scores during and upon exit of the PACU as compared with the postclosure group. In addition, the preincision cohort also trended toward lower opioid consumption while in the PACU. Consideration should be given to the routine use of preincision injection of local anesthesia to maximize pain relief in a multimodal pain strategy in hand surgical patients. Level of Evidence Therapeutic level III.

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Thumb Basal Joint Arthroplasty: Prospective Comparison of Perioperative Analgesia and Opioid Consumption

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2016.07.044 ◽

2016 ◽

Vol 41 (9) ◽

pp. S26 ◽

Cited By ~ 1

Author(s):

Andrew J. Miller ◽

Nayoung Kim ◽

Asif Ilyas

Keyword(s):

Joint Arthroplasty ◽

Opioid Consumption ◽

Perioperative Analgesia ◽

Prospective Comparison ◽

Basal Joint

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Survey Criteria for Fibromyalgia Independently Predict Increased Postoperative Opioid Consumption after Lower-extremity Joint Arthroplasty

Anesthesiology ◽

10.1097/aln.0b013e3182a8eb1f ◽

2013 ◽

Vol 119 (6) ◽

pp. 1434-1443 ◽

Cited By ~ 110

Author(s):

Chad M. Brummett ◽

Allison M. Janda ◽

Christa M. Schueller ◽

Alex Tsodikov ◽

Michelle Morris ◽

...

Keyword(s):

Postoperative Pain ◽

Lower Extremity ◽

Pain Control ◽

Joint Arthroplasty ◽

Opioid Consumption ◽

Self Report ◽

Pain Severity ◽

Anesthetic Technique ◽

Opioid Use ◽

Postoperative Pain Control

Abstract Background: Variance in pain after total knee and hip arthroplasty may be due to a number of procedural and peripheral factors but also, in some individuals, to aberrant central pain processing as is described in conditions like fibromyalgia. To test this hypothesis, the authors conducted a prospective, observational cohort study of patients undergoing lower-extremity joint arthroplasty. Methods: Five hundred nineteen patients were preoperatively phenotyped using validated self-reported pain questionnaires, psychological measures, and health information. In addition to being assessed for factors previously found to be associated with poor outcomes in arthroplasty, participants also completed the American College of Rheumatology survey criteria for fibromyalgia. Previous studies have suggested that rather than being “present” or “absent,” features of fibromyalgia as measured by this instrument, occur over a wide continuum. Postoperative pain control was assessed by total postoperative opioid consumption. Results: Preoperatively, patients with higher fibromyalgia survey scores were younger, more likely to be female, taking more opioids, reported higher pain severity, and had a more negative psychological profile. In the multivariate analysis, the fibromyalgia survey score, younger age, preoperative opioid use, knee (vs. hip), pain severity at baseline, and the anesthetic technique were all predictive of increased postoperative opioid consumption. Conclusions: The use of the survey criteria for fibromyalgia led to the finding of distinct phenotypic differences, and the measure was independently predictive of opioid consumption. This self-report measure may provide an additional simple means of predicting postoperative pain outcomes and analgesic requirements. Future studies are needed to determine whether tailored therapies can improve postoperative pain control in this population.

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Thumb Basal Joint Arthroplasty: Prospective Comparison of Perioperative Analgesia and Opioid Consumption

Orthopedics ◽

10.3928/01477447-20180409-04 ◽

2018 ◽

Vol 41 (3) ◽

pp. e410-e415 ◽

Cited By ~ 2

Author(s):

Andrew J. Miller ◽

Michael Livesey ◽

Dennis P. Martin ◽

Jack Abboudi ◽

William H. Kirkpatrick ◽

...

Keyword(s):

Joint Arthroplasty ◽

Opioid Consumption ◽

Perioperative Analgesia ◽

Prospective Comparison ◽

Basal Joint

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Retrospective analysis on the effect of spinal cord stimulation on opioid consumption

Pain Management ◽

10.2217/pmt-2020-0016 ◽

2020 ◽

Author(s):

Awinita Barpujari ◽

Michael A Erdek

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Retrospective Analysis ◽

Spinal Cord Stimulation ◽

Alternative Therapy ◽

Opioid Consumption ◽

Opioid Use ◽

Number Of Patients ◽

Chronic Pain Conditions ◽

Post Trial

Aim: Spinal cord stimulation (SCS) is used to clinically manage and/or treat several chronic pain etiologies. A limited amount is known about the influence on patients' use of opioid pain medication. This retrospective analysis evaluated SCS effect on opioid consumption in patients presenting with chronic pain conditions. Materials & methods: Sixty-seven patients underwent a temporary trial device, permanent implant or both. Patients were divided for assessment based on the nature of their procedure(s). Primary outcome was change in morphine equivalent dose (MED), ascertained from preoperative and postoperative medication reports. Results: Postoperative MED was significantly lower in patients who received some form of neuromodulation therapy. Pretrial patients reported an average MED of 41.01 ± 10.23 mg per day while post-trial patients reported an average of 13.30 ± 5.34 mg per day (p < 0.001). Pre-implant patients reported an average MED of 39.14 ± 13.52 mg per day while post-implant patients reported an average MED of 20.23 ± 9.01 mg per day (p < 0.001). There were no significant differences between pre-trial and pre-implant MED, nor between post-trial and post-implant MED. Of the 42 study subjects who reported some amount of pre-intervention opioid use, 78.57% indicated a lower MED (n = 33; p < 0.001), 16.67% indicated no change (n = 7) and 4.76% (n = 2) indicated a higher MED, following intervention. Moreover, SCS therapy resulted in a 26.83% reduction (p < 0.001) in the number of patients with MED >50 mg per day. Conclusion: Spinal cord stimulation may reduce opioid use when implemented appropriately. Neuromodulation may represent alternative therapy for alleviating chronic pain which may avoid a number of deleterious side effects commonly associated with opioid consumption.

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Opioid Consumption Patterns and Prolonged Opioid Use Among Opioid-Naïve Ankle Fracture Patients

Foot & Ankle Specialist ◽

10.1177/1938640021992922 ◽

2021 ◽

pp. 193864002199292

Author(s):

Hope Skibicki ◽

Sundeep Saini ◽

Ryan Rogero ◽

Kristen Nicholson ◽

Rachel J. Shakked ◽

...

Keyword(s):

Ankle Fracture ◽

Monitoring Program ◽

Opioid Consumption ◽

Consumption Patterns ◽

Utilization Rate ◽

Opioid Use ◽

Index Procedure ◽

Postoperative Visit ◽

Fracture Surgery

Introduction Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Here, the investigators assess immediate postoperative opioid consumption patterns as well as the incidence of prolonged opioid use among opioid-naïve patients following ankle fracture surgery. Methods Included patients underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture over a 1-year period. At patients’ first postoperative visit, opioid pills were counted and standardized to the equivalent number of 5-mg oxycodone pills. Prolonged use was defined as filling a prescription for a controlled substance more than 90 days after the index procedure, tracked by the New Jersey Prescription Drug Monitoring Program up to 1 year postoperatively. Results At the first postoperative visit, 173 patients consumed a median of 24 out of 40 pills prescribed. The initial utilization rate was 60%, and 2736 pills were left unused. In all, 32 (18.7%) patients required a narcotic prescription 90 days after the index procedure. Patients with a self-reported history of depression (P = .11) or diabetes (P = .07) demonstrated marginal correlation with prolonged narcotic use. Conclusion Our study demonstrated that, on average, patients utilize significantly fewer opioid pills than prescribed and that many patient demographics are not significant predictors of continued long-term use following outpatient ankle fracture surgery. Large variations in consumption rates make it difficult for physicians to accurately prescribe and predict prolonged narcotic use. Level of Evidence: Level III

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Thumb-Basal Joint Arthroplasty Outcomes and Metacarpal Subsidence: A Prospective Cohort Analysis of Trapeziectomy With Suture Button Suspensionplasty Versus Ligament Reconstruction With Tendon Interposition

Hand ◽

10.1177/1558944721994227 ◽

2021 ◽

pp. 155894472199422

Author(s):

Owolabi Shonuga ◽

Kristen Nicholson ◽

Jack Abboudi ◽

Gregory Gallant ◽

Christopher Jones ◽

...

Keyword(s):

Ligament Reconstruction ◽

Demographic Data ◽

Cohort Analysis ◽

Joint Arthroplasty ◽

Pinch Strength ◽

Complication Rates ◽

Suture Button ◽

Basal Joint ◽

Tendon Interposition ◽

Cmc Joint

Background Thumb carpometacarpal (CMC) joint arthroplasty is a common procedure in the surgical management of symptomatic thumb basal joint arthritis. Following trapeziectomy, a number of suspensionplasty techniques are often used, but limited comparative evidence exists between these techniques. The central aim of this study was to prospectively compare the outcomes of 2 suspensionplasty techniques following trapeziectomy: suture button (TightRope) versus ligament reconstruction and tendon interposition (LRTI). Methods Prospective data were collected on 112 consecutive patients with Eaton stage III-IV thumb CMC arthritis who underwent open trapeziectomy and suspensionplasty. There were 53 LRTI and 59 TightRope suspensionplasty procedures. Outcomes were measured using the Quick Disabilities of the Arm, Shoulder, and Hand ( QuickDASH) questionnaire, Visual Analogue Scale (VAS) for pain, radiographic analysis, and lateral pinch strength. Patient demographic data and complications were also recorded. Results Patients undergoing TightRope suspensionplasty had significantly higher trapeziometacarpal index and thus less subsidence than the LRTI group at 2 weeks (0.22 vs 0.17 [ P < .0001]) and 3 months (0.17 vs 0.15 [ P < .05]) postoperatively. TightRope suspensionplasty also had a significantly lower QuickDASH score at 2 weeks (64.7 vs 74.6 [ P < .05]), 3 months (20.7 vs 32.5 [ P < .05]), and 1 year postoperatively (7.57 vs 21.5 [ P < .05]) compared with the LRTI group. However, there was no difference in VAS pain, lateral pinch strength, reoperation, or complications at any time point between groups. Conclusions Thumb CMC joint arthroplasty performed with a TightRope suspensionplasty versus LRTI yielded short-term improved resistance to subsidence, long-term greater improvement in clinical outcome by QuickDASH, and no difference in pain or complication rates.

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