scholarly journals How Does Perioperative Ketorolac Affect Opioid Consumption and Pain Management After Ankle Fracture Surgery?

2020 ◽  
Vol 478 (1) ◽  
pp. 144-151 ◽  
Author(s):  
Elizabeth L. McDonald ◽  
Joseph N. Daniel ◽  
Ryan G. Rogero ◽  
Rachel J. Shakked ◽  
Kristen Nicholson ◽  
...  
Keyword(s):  
Pain Management ◽  
Ankle Fracture ◽  
Opioid Consumption ◽  
Fracture Surgery

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

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

scholarly journals Opioid Consumption Patterns and the Risk of Prolonged Opioid Use Among Opioid-Naïve Patients Following Ankle Fracture Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0006
Author(s):  
Hope Skibicki ◽  
Sundeep Saini ◽  
Ryan Rogero ◽  
Kristen Nicholson ◽  
Rachel J. Shakked ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
The United States ◽  
Opioid Consumption ◽  
Consumption Patterns ◽  
Opioid Use ◽  
Index Procedure ◽  
Factors Associated ◽  
Tibial Plafond ◽  
Significant Difference ◽  
Fracture Surgery

Category: Ankle Introduction/Purpose: Over the past two decades, the number of opioids dispensed in the United States has nearly tripled. Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Statewide Prescription Drug Monitoring Programs (PDMPs) have been implemented to deter overprescribing and help monitor information pertaining to suspected abuse. The purpose of this study was to assess the immediate postoperative opioid consumption patterns as well as the incidence of new prolonged opioid use among opioid naïve patients following ankle fracture surgery. Methods: This was a retrospective review of prospectively collected data. Patients were included if they underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture between October 2016 and September 2017. Patients were excluded if they received any narcotic prescriptions prior to the date of the initial injury. Patient demographics, medical history, fracture pattern, and opioid prescription and consumption details were collected. The morphine equivalent dose was calculated for each prescription and then converted to the equivalent of a 5-mg oxycodone “pill”. The New Jersey PDMP was used to determine all prescriptions of controlled substances filled up to 1 year postoperatively. Prolonged use was defined as filling a postoperative prescription for a controlled substance 90 days after the index procedure. Linear regression analysis was performed to identify independent factors associated with immediate postoperative opioid consumption and repeated to identify factors associated with prolonged use. Results: One-hundred seventy-one patients were included in this study. At the first postoperative visit, patients consumed a median of 24 pills, whereas the median number prescribed was 40. This resulted in an initial utilization rate of 60% and 2,736 pills left unused. Additionally, we found that 18.7% (n=32) of patients required a narcotic prescription after 90 days from the index procedure. There was no statistically significant difference found between specific fracture type (isolated distal fibula, bimalleolar, trimalleolar) and prolonged opioid consumption, however tibial plafond fractures could not be included due to insufficient sample size (n=5). Patients with a self-reported history of depression (p=.094) or diabetes (p=.097) demonstrated marginal correlation with prolonged narcotic use. Conclusion: Our study demonstrated that patients who underwent outpatient surgical fixation of an ankle or tibial plafond fracture were initially overprescribed narcotics by nearly 67%, leaving a significant quantity of pills unused for potential abuse or diversion. 18.7% of originally opioid naïve patients required continued analgesia 90 days after the index procedure, however large variations in consumption rates make it difficult for physicians to predict prolonged narcotic use.

The Effects of Anesthetic Technique on Postoperative Opioid Consumption in Ankle Fracture Surgery

2016 ◽  
Vol 32 (10) ◽  
pp. 870-874 ◽  
Author(s):  
Kristian P. Christensen ◽  
Ann M. Møller ◽  
Jesper K. Nielsen ◽  
Tobias W. Klausen ◽  
Rune Sort
Keyword(s):  
Ankle Fracture ◽  
Opioid Consumption ◽  
Anesthetic Technique ◽  
Fracture Surgery

scholarly journals A Prospective Randomized Study Evaluating the Effect of Perioperative NSAIDs on Opioid Consumption and Pain Management After Ankle Fracture Surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0008 ◽  
Author(s):  
Elizabeth McDonald ◽  
Joseph Daniel ◽  
Kristen Nicholson ◽  
Rachel Shakked ◽  
Steven Raikin ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Bone Healing ◽  
Ankle Fracture ◽  
Drug Regimen ◽  
The United States ◽  
Opioid Consumption ◽  
Ankle Fractures ◽  
Opioid Medication ◽  
Narcotic Analgesia

Category: Trauma Introduction/Purpose: Currently there is an epidemic in the United States regarding opioid abuse. This has resulted in strict government prescribing regulations throughout the country and increasing efforts by orthopaedic surgeons to better manage postoperative narcotic analgesia. Non-steroidal anti-inflammatory drugs (NSAIDs) can serve as a powerful adjunct in managing postoperative pain and in turn minimize the need for opioid medications. It has recently been shown that ketorolac can be used after open reduction and internal fixation (ORIF) of ankle fractures without interfering with bone healing. Therefore, we set out to evaluate whether including ketorolac in the postoperative drug regimen reduces opioid consumption and pain after ORIF of ankle fractures. Methods: 128 patients undergoing ORIF of an ankle fracture were prospectively randomized to treatment with or without ketorolac. Patients also had the option to simultaneously undergo regional anesthesia. Patients assigned to the treatment group were given 30 mg of IV ketorolac intraoperatively; prescribed 20 tablets of ketorolac 10 mg PO Q6 H and 30 tablets of Oxycodone/Acetaminophen 5/325 Q4-6 H PRN. Patients assigned to the control group were given 30 tablets of oxycodone/acetaminophen 5/325 Q4-6 H PRN only. A survey was distributed via Research Electronic Data Capture (REDCap) on postoperative days 1-7. Patients were asked to report their daily opioid consumption, pain level using the Visual Analog Scale (VAS), satisfaction with pain management, and side effects. Intention-to-treat analysis was performed. Normality of data was tested using the Shapiro-Wilk test. Differences between the control and treatment groups were tested using Mann-Whitney U or Student’s t-tests. Results: 105/128 (82%) patients with mean BMI of 29.3 completed all study requirements. 54 received ketorolac with opioid medication and 51 received opioids alone. 43 men (41%) and 62 women (59%) participated with mean age of 48 years. Patients receiving ketorolac required less oxycodone/acetaminophen (p<0.013) and reported less pain (p<0.048) during postoperative days 1 and 2 compared to control patients(Figure 1). While opioid consumption did not significantly differ after day 2, patients treated with ketorolac maintained less pain (days 1-4, p<0.028); better sleep (days 1-5, p<0.037); lower frequency of pain (days 1-3; p<0.017); and greater satisfaction with pain management (days 1-3, p<0.047). Hypersensitivity was significantly less on day 1 (p=0.036) and paresthesias on day 3 (p=0.011). Surprisingly, there was no difference in nausea/constipation between groups (p>0.139). Conclusion: The addition of ketorolac to the postoperative drug regimen significantly reduced pain, while decreasing the use of opioid medication following ORIF of ankle fractures early in the postoperative period. Better pain management during postoperative days 1 and 2 is particularly important because patients on average consume the most opioids during this time. With the assurance that ketorolac does not interfere with bone healing, this NSAID is a valuable tool for helping patients manage postoperative pain with less narcotic analgesia.

Beware the rebound effect: regional anesthesia increases opioid utilization after humerus fracture surgery

2021 ◽  
pp. 175857322110481
Author(s):  
Daniel J. Cunningham ◽  
Micaela A. LaRose ◽  
Gloria X. Zhang ◽  
Ariana R. Paniagua ◽  
Christopher S. Klifto ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Proximal Humerus ◽  
Rebound Effect ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Opioid Consumption ◽  
Humeral Shaft ◽  
Patients Âgés ◽  
The Impact ◽  
Fracture Surgery

Introduction Regional anesthesia (RA) is used reduce pain in proximal humerus and humeral shaft fracture surgery. The study hypothesis was that RA would decrease opioid demand in patients undergoing fracture surgery. Materials and methods Opioid demand was recorded in all patients ages 18 and older undergoing proximal humerus or humeral shaft fracture surgery at a single, Level I trauma center from 7/2013 – 7/2018 (n = 380 patients). Inpatient opioid consumption from 0–24, 24–48, and 48–72 h and outpatient opioid demand from 1-month pre-operative to 90-days post-operative were converted to oxycodone 5-mg equivalents (OE's). Unadjusted and adjusted models were constructed to evaluate the impact of RA and other factors on opioid utilization. Results Adjusted models demonstrated increases in inpatient opioid consumption in patients with RA (6.8 estimated OE's without RA vs 8.8 estimated OE's with RA from 0–24 h post-op; 10 vs 13.7 from 24–48 h post-op; and 8.7 vs 11.6 from 48–72 h post-op; all p < 0.05). Estimated cumulative outpatient opioid demand was significantly higher in patients with RA at all timepoints. Discussion In proximal humerus and humeral shaft fracture surgery, RA was associated with increased inpatient and outpatient opioid demand after adjusting for baseline patient and treatment characteristics.

Wound-Healing Issues Following Rotational Ankle Fracture Surgery: Predictors and Local Management Options

2018 ◽  
Vol 12 (5) ◽  
pp. 409-417 ◽  
Author(s):  
Hesham Saleh ◽  
Sanjit Konda ◽  
Adam Driesman ◽  
John Stranix ◽  
Catherine Ly ◽  
...  
Keyword(s):  
Wound Healing ◽  
Ankle Fracture ◽  
Wound Complications ◽  
Management Options ◽  
Original Cohort ◽  
Surgical Interventions ◽  
Postoperative Wound ◽  
Trimalleolar Fractures ◽  
Medical Histories ◽  
Fracture Surgery

Background. The incidence and risk factors of wound-healing complications following rotational ankle fracture surgery are well documented in the literature. However, there is a paucity regarding management options following these complications. The goal of this study was to provide a descriptive analysis of one surgeon’s experience managing wound complications in patients who have undergone ankle fracture surgery. Methods. A total of 215 patients who were operatively treated for an unstable ankle were retrospectively identified. Patient demographics, medical histories, initial injury characteristics, surgical interventions, and clinical follow-up were collected. Twenty-five of these patients developed postoperative wound problems. Results. Of the original cohort of 215 patients, 25 (11.6%) developed wound-healing complications. Their average age was 53.6 ± 18.0 years; there were 12 males (48.0%). Connective tissue/inflammatory disease (odds ratio [OR] 3.9), cardiovascular disease (OR 3.6), and active smoking (OR 3.3) were associated with an increased likelihood of developing postoperative wound complications. With regard to injuries, open fractures (OR 17.9) had the highest likelihood of developing postoperative complications, followed by type 44-C (OR 2.8) and trimalleolar fractures (OR 2.0). Conclusion. Wound complications following open treatment of ankle fractures occurred with an incidence of 11.6% in this series, of which only about half required operative intervention. A third of wounds were managed by orthopaedics in conjunction with plastic surgery. Levels of Evidence: Level III: Retrospective comparative study

Trends in Urgent Care Utilization Following Ankle Fracture Fixation

2018 ◽  
Vol 40 (2) ◽  
pp. 218-223 ◽  
Author(s):  
Mostafa M. Abousayed ◽  
Christopher K. Johnson ◽  
Muhammad Moral ◽  
Sarah Sternbach ◽  
Andrew J. Rosenbaum
Keyword(s):  
Psychiatric Disorders ◽  
Healthcare System ◽  
Ankle Fracture ◽  
Univariate Analysis ◽  
Care Facility ◽  
Urgent Care ◽  
Care Utilization ◽  
Level Of Evidence ◽  
Patients With Diabetes ◽  
Fracture Surgery

Background: The Centers for Medicare and Medicaid services (CMS) have implemented initiatives to improve postdischarge care and reduce unnecessary readmissions. Readmissions within 30 days are frequent and represent an economic burden on both patients and the healthcare system. The aim of this study was to evaluate the frequency and causes for urgent care visits within 30 days of discharge after ankle open reduction and internal fixation (ORIF) and determine factors correlated with such visits. Methods: This was a retrospective analysis of prospectively collected data. All patients who underwent ankle ORIF at our institution between July 1, 2016, and June 30, 2017, were included. Patients were identified using Current Procedural Terminology (CPT) codes for ankle ORIF. Patients’ demographics including age, sex, race, body mass index, occupation, insurance payer, and comorbidities were documented. Results: Thirty-five patients (10.51%) had urgent care visits within 30 days of discharge. Patients presented at a mean of 11.8 days after the day of surgery. Sixteen patients (45.71%) had cast/splint-related issues, 7 (20%) presented with pain, and 7 (20%) with increased operative site drainage. Univariate analysis demonstrated a statistically significant association between postoperative urgent care visits and patients with diabetes ( P = .03) or underlying psychiatric disorders ( P = .03). Conclusion: In this population study of patients undergoing ankle fracture surgery, we found that the rate of urgent care visits within 30 days of discharge exceeded the rate of inpatient readmission. Additionally, patients with diabetes and psychiatric disorders were significantly more likely to present to an urgent care facility postoperatively, potentially accounting for increased expenditures of the healthcare system. Level of Evidence: Level III, comparative series.

Sign in / Sign up

Export Citation Format

Share Document