scholarly journals A Prospective Evaluation of Opioid Consumption Following Orthopaedic Foot and Ankle Surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0010
Author(s):  
Sundeep Saini ◽  
Elizabeth McDonald ◽  
Kristen Nicholson ◽  
Ryan Rogero ◽  
Megan Chapter ◽  
...  
Keyword(s):  
Drug Prescription ◽  
Median Number ◽  
Opioid Consumption ◽  
Consumption Patterns ◽  
Utilization Rate ◽  
Foot And Ankle ◽  
Narcotic Drug ◽  
Opioid Prescription ◽  
Forefoot Surgery ◽  
Ankle Surgery

Category: Other Introduction/Purpose: The purpose of our study was to assess opioid consumption patterns following outpatient orthopaedic foot and ankle procedures in order to develop a pragmatic approach to narcotic drug prescription. Methods: Patients undergoing outpatient orthopaedic foot and ankle procedures who met inclusion criteria had the following prospective information collected: patient demographics, preoperative health history and Visual Analog Scale (VAS), anesthesia type, procedural details, and opioid prescription and consumption details. Utilization rates were compared using the Man-Whitney Test or the Kruskall-Wallis analysis of variance test with post-hoc Dunn’s multiple comparison test. Results: A total of 1,009 of 1,027 patients were included in this study (mean age: 49 years). Overall, patients consumed a median of 20 pills whereas the median number of pills prescribed was 40. This resulted in a utilization rate of 51% and nearly 21,196 pills left unused. Patients who received forefoot surgery used 6 pills less than those receiving hindfoot/ankle surgery (p=0.002). Patients between the ages of 60-79 consumed significantly less than those between 18-59 years old (p<0.012). Patients with preoperative VAS score =77 (p=0.002) or self-reported anxiety (p=0.070) a had an increase in opioid consumption compared to those who did not. Conclusion: Our study demonstrates that patients who undergo orthopaedic foot and ankle procedures are overprescribed narcotic medication by nearly twice the amount that is actually consumed. This leads to a significant surplus of narcotics available for potential diversion. We recommend that surgeons judiciously administer opioid prescriptions based on their patients’ consumption patterns and anatomic location of surgery.

Prospective Evaluation of Utilization Patterns and Prescribing Guidelines of Opioid Consumption Following Orthopedic Foot and Ankle Surgery

2018 ◽  
Vol 39 (11) ◽  
pp. 1257-1265 ◽  
Author(s):  
Sundeep Saini ◽  
Elizabeth L. McDonald ◽  
Rachel Shakked ◽  
Kristen Nicholson ◽  
Ryan Rogero ◽  
...  
Keyword(s):  
Standard Error ◽  
The United States ◽  
Median Number ◽  
Opioid Consumption ◽  
Utilization Rate ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Opioid Prescription ◽  
Factors Associated ◽  
Patient Reported

Background: Overprescription of narcotic pain medication is a major culprit in the present opioid epidemic plaguing the United States. The current literature on lower extremity opioid usage has limitations and would benefit from additional study. The purpose of our study was to prospectively assess opioid consumption patterns following outpatient orthopedic foot and ankle procedures. Methods: Patients undergoing outpatient orthopedic foot and ankle procedures who met inclusion criteria had the following prospective information collected: patient demographics, preoperative health history, patient-reported outcomes, anesthesia type, procedure type, opioid prescription and consumption details. The morphine equivalent dose was calculated for each prescription and then converted to the equivalent of a 5-mg oxycodone “pill.” Univariable analyses were performed to identify variables with a statistically robust association with opioid consumption for inclusion in a multivariable linear regression. A stepwise backward regression was then performed to identify independent predictors of opioid consumption. Postoperative opioid utilization was reported for 988 patients (mean age: 49 years). Results: Overall, patients consumed a median of 20 pills whereas the median number of pills prescribed was 40. This resulted in a utilization rate of 50% and 20 631 pills left unused. Independent factors associated with higher opioid consumption were anesthesia type ( P < .004), age <60 years ( P < .001), preoperative visual analog scale (VAS) pain report of >6 ( P = .008), and bony procedures ( P = .008); residual standard error 16.73 ( F7,844=14.3, P < .001). Conclusion: Our study found that patients who underwent orthopedic foot and ankle procedures were overprescribed narcotic medication by nearly twice the amount that was actually consumed. Although we identified 4 independent factors associated with opioid consumption, the large residual standard error suggests that there remains a substantial degree of unexplained variance of opioid consumption observed in the patient population. Physicians face a challenging task of setting appropriate protocols when balancing pain relief and generalizable guidelines. Level of Evidence: Level II, prospective observational cohort study.

Prospective Evaluation of Opioid Use After Adoption of a Prescribing Guideline for Outpatient Foot and Ankle Surgery

2019 ◽  
Vol 40 (11) ◽  
pp. 1260-1266
Author(s):  
Abhiram R. Bhashyam ◽  
Cornelia Keyser ◽  
Christopher P. Miller ◽  
Jennifer Jacobs ◽  
Eric Bluman ◽  
...  
Keyword(s):  
Opioid Consumption ◽  
Prescription Opioid ◽  
Foot And Ankle ◽  
Opioid Use ◽  
Level Of Evidence ◽  
Opioid Prescription ◽  
Provider Group ◽  
Use Patterns ◽  
Ankle Surgery ◽  
Pill Counts

Background: In 2016, our provider group adopted an initial prescription opioid maximum guideline to reduce overprescription of opioids. The purpose of this study was to prospectively assess opioid consumption patterns following implementation of this guideline in patients undergoing outpatient foot and ankle surgery. Methods: Over a 1-year period, we prospectively analyzed opioid prescription and use patterns of 303 consecutive patients. Opioid consumption was verified by pill counts completed at the 2- and 6-week postoperative visits. The morphine equivalent dose was calculated for each prescription and converted to the equivalent 5-mg oxycodone “pill.” We used the regression coefficients from a regression model of opioid consumption to create a revised guideline for maximum initial opioid prescriptions based on patient age, bony vs nonbony procedure, and anatomic location (forefoot/midfoot/hindfoot/ankle). Results: On average, 37.4 pills were prescribed and 18.9 pills used (47.6% utilization). Only 17.2% of patients used their full prescription quantity. By 2 weeks, 88% of patients no longer used opioids. Only 1.3% of patients used prescription opioids beyond 6 weeks. Independent risk factors for increased opioid consumption were younger age ( P = .003), male sex ( P = .007), recent preoperative opioid use ( P = .019), bony procedures ( P < .001), and ankle/hindfoot procedures ( P = .016 and P < .001). Conclusion: This study showed the amount of opioid consumption for patients undergoing foot and ankle procedures. We present a modified guideline for the maximum initial prescription of opioids following outpatient foot and ankle procedures that can be used as a benchmark for further study in decreasing overprescribing. Level of Evidence: Level II, prospective observational cohort study.

scholarly journals Patient Reported Opioid Consumption Following Outpatient Foot and Ankle Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0007
Author(s):  
Samuel F. Thompson ◽  
Zackary P. Burrow ◽  
Scott H. Conant ◽  
Samantha P. Kelly ◽  
Evan S. Fene ◽  
...  
Keyword(s):  
Median Number ◽  
Opioid Consumption ◽  
Pain Level ◽  
Foot And Ankle ◽  
Prescribing Practices ◽  
Preoperative Pain ◽  
Orthopedic Surgeons ◽  
Ankle Surgery ◽  
Patient Reported ◽  
Analgesic Medication

Category: opioid consumption Introduction/Purpose: The expanding opioid crisis has forced orthopedic surgeons to evaluate their prescribing practices, yet there remains limited evidence to guide providers in achieving safe and effective postoperative analgesia. Our goal was to prospectively evaluate opioid consumption following outpatient foot and ankle surgery and determine predictors of increased narcotic usage. Methods: We prospectively enrolled adult patients scheduled for outpatient foot and ankle surgery and conducted phone and in- person interviews postoperatively to determine pain level, number of pills consumed, satisfaction with pain control, and whether other analgesic medication was used. Interviews were performed at four separate time points: 5 days, 10 days, 2 weeks, and 6 weeks following surgery. Additional data collected included age, gender, payer status, education level, preoperative pain level, procedure performed, whether opioid pain medication had been used by the patient in the 12 months preceding surgery, and the amount of narcotic prescribed postoperatively. Results: Complete data was available for 52 patients (median age, 42 years). The median number of opioids prescribed postoperatively was 45 pills (337.5 morphine milligram equivalents (MMEs)). A refill narcotic prescription was provided for 36.5% of patients. The number of opioid pills consumed following surgery ranged from 0 to 120 (median, 40 pills). Forty-six percent of patients had discontinued the use of opioids by post-op day 10 and 86.5% by post-op day 20. Increased pre-operative pain level (p = 0.02) and an increased quantity of pills prescribed at the first prescription (<0.0001) were significantly associated with increased narcotic consumption. Eighteen (39.1%) patients filled a narcotic prescription in the 12 months prior to surgery, however, narcotic use prior to surgery did not significantly increase total opioid consumption. Conclusion: We found that the median number of opioids consumed following outpatient foot and ankle surgery was 40 pills. Nearly 90% of patients had discontinued narcotic use by 20 days postoperatively. Pre-operative pain level and the number of pills provided at the first prescription were predictive of increased narcotic usage.

scholarly journals Opioid Consumption and Time to Return to Work After Percutaneous Foot and Ankle Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0001
Author(s):  
Jimmy J. Chan ◽  
Javier Z. Guzman ◽  
Kevin K. Chen ◽  
Jesse C. Chan ◽  
Ettore Vulcano
Keyword(s):  
Soft Tissue ◽  
Return To Work ◽  
Opioid Consumption ◽  
Foot And Ankle ◽  
Foot Surgery ◽  
Average Return ◽  
Forefoot Surgery ◽  
Ankle Surgery ◽  
The Usa ◽  
Long Acting

Category: Hindfoot, Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Orthopaedic surgeons are the 5th highest prescriber for narcotics in the USA. Foot and ankle procedures can be amongst some of the more painful procedures in orthopedics. A recent study demonstrated that patient underwent open foot and ankle surgeries averaged 27.2 tablets of narcotics with 37% of patients unwilling to stop at 3-month post-operative visit. Percutaneous techniques for foot and ankle procedures were recently approved in the U.S., which allow for significantly smaller incisions and minimal soft tissue disruption, which may potentially decrease post-operative pain and allow faster recovery. The purpose of this study is to assess the total opioid consumption and time for return to work following percutaneous foot and ankle surgery. Methods: In this prospective cohort study, 50 consecutive patients underwent percutaneous foot surgery (bony procedures with or without soft tissue work) by a single surgeon. All surgeries were outpatient procedures and performed under general anesthesia with a long-acting popliteal nerve block. All patients were prescribed 30 tablets of 5 mg oxycodone, 50 tablets of 500 mg acetaminophen, and 9 tablets of 600 mg ibuprofen post-operatively for pain control. All patients were given a log sheet to record number of pain medications taken during the first 14 post-operative days. The log sheet and leftover pills were collected and counted to confirm the amount of pain medication used at 2-week post-operative visit. Time return to work was also recorded in subsequent follow-up appointment. Results: All 50 patients returned their log sheet at 2-week post-operative visit. Mean age was 47.1 years. N=36 (72%) were forefoot surgeries, N=2 (4%) midfoot, N=9 (18%) hindfoot, and N=3 (6%) combined. Average oxycodone tablets taken during the first 14 days after surgery was 3.3 tablets. By the 14th day, no patient was taking any narcotic medication. The average return to work was 18.9 days post-operatively. Patients with forefoot surgery averaged 2.2 tablets of oxycodone with return to work at 10.4 days. Midfoot surgery patients averaged 3.5 tablets with return to work at 33 days. Hindfoot surgery patients averaged 5.3 tablets with return to work at 38.9 days. Combined foot surgery patients averaged 11 tablets with return to work at 54.3 days. Conclusion: This study demonstrated that percutaneous foot and ankle surgery has significant reduction and cessation in narcotic consumption post-operatively when compared to the reported values with open procedures in current literature.

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 Medical Malpractice Trends in Foot and Ankle Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0004
Author(s):  
Rishin J. Kadakia ◽  
Keith Orland ◽  
Akhil Sharma ◽  
Jie Chen ◽  
Craig C. Akoh ◽  
...  
Keyword(s):  
Medical Malpractice ◽  
Orthopaedic Surgery ◽  
Nonoperative Treatment ◽  
Anatomical Location ◽  
Foot And Ankle ◽  
Common Complication ◽  
Adult Females ◽  
Forefoot Surgery ◽  
Ankle Surgery ◽  
Malpractice Claims

Category: Other Introduction/Purpose: Medical malpractice lawsuits can place significant economic and psychologic burden on a provider. Orthopaedic surgery is one of the most common subspecialties involved in malpractice claims. There is currently no study examining malpractice lawsuits within foot and ankle surgery. Accordingly, the purpose of this work is to examine trends in malpractice claims in foot and ankle surgery. Methods: The Westlaw legal database was queried for lawsuits pertaining to foot and ankle surgery from 2008 to 2018. Only cases involving medical malpractice were included for analysis. All available details pertaining to the cases were collected. This included plaintiff demographic and geographic data. Details regarding the cases were also collected such as anatomical location, pathology, complications, and case outcomes. Results: Forty nine malpractice lawsuits pertaining to foot and ankle were identified. Most plaintiffs in these cases were adult females, and the majority of cases occurred in the northeast (53.1%). The most common anatomical region involved in claims involved the forefoot (29%). The majority of these claims involved surgery (65%). Infection was the most common complication seen in claims (22%). The jury ruled in favor of the defendant surgeon in most cases (73%). Conclusion: This is the first study to examine trends in medical malpractice within foot and ankle surgery. Infection was the most frequent complication seen in claims and forefoot surgery was the most common anatomic location. A large portion of claims resulted after nonoperative treatment. A better understanding of the trends within malpractice claims is crucial to developing strategies for prevention.

scholarly journals Outcome Following Lower Extremity Nerve Block during Foot and Ankle Surgery: A Systematic Review

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0022
Author(s):  
Arianna L. Gianakos ◽  
Filippo Romanelli ◽  
Malaka Badri ◽  
Naina Rao ◽  
Bart Lubberts ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Postoperative Pain ◽  
Continuous Infusion ◽  
Nerve Block ◽  
Opioid Consumption ◽  
Foot And Ankle ◽  
Complication Risk ◽  
Prospective Comparison ◽  
Ankle Surgery

Category: Ankle; Other Introduction/Purpose: The purpose of this study was to perform a systematic review of the current literature assessing the management of pain with various block techniques in the perioperative period during elective foot and ankle surgery. Methods: A review of the literature was performed according to the PRISMA guidelines. Medline, Embase, and Cochrane databases were searched on October 1, 2019. Studies were identified by using synonyms for ‘foot’, ‘ankle’, ‘pain management’, ‘opioid’ and ‘nerve block’. Inclusion criteria were studies that 1) reported and compared the outcomes following various types of peripheral nerve blocks in in foot and ankle surgery, 2) were published in the English language, and 3) were published within the last 10 years. Results: Twenty-four articles evaluating 4,640 patients were included. Sixty-seven percent were randomized controlled trials, 17% were prospective comparison studies, and 17% were retrospective comparison studies. Nerve block techniques included: femoral, adductor canal, sciatic, popliteal, saphenous, and ankle. Ropivacaine and bupivacaine were most commonly utilized. Postoperative opioid consumption and postoperative pain levels were reduced with use of PNB when compared with systemic/local anesthesia, in patients receiving combined popliteal/femoral block, and in patients receiving continuous infusion popliteal block [Table 1, Table 2]. Studies demonstrated higher satisfaction with PNB, continuous infusion, and dual injections [Table 3]. One study reported 7% neurologic related complication risk and demonstrated a higher complication rate when with popliteal versus ankle block. All other studies were equivocal or failed to mention complications. Conclusion: Optimal pain management for elective foot and ankle surgery remains controversial and an ideal protocol from a risk-benefit perspective regarding use of PNB has yet to be established. Our study demonstrates improvements in postoperative pain levels, opioid consumption, and length of stay in patients receiving a PNB when compared with systemic anesthesia. Combined PNB and dual catheter administration may improve outcomes. Unfortunately, little data has been published on risks and tradeoffs in order to help guide patients and surgeons with a well informed shared decision making model. Future studies are needed to better clarify any respective tradeoffs to these options. [Table: see text]

scholarly journals Trends of Foot and Ankle Publishing in JBJS[A] over a 15 Year Period From 2004-2018

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0010
Author(s):  
Bradley Alexander ◽  
James Hicks ◽  
Abhinav Agarwal ◽  
Aaradhana J. Jha ◽  
Spaulding F. Solar ◽  
...  
Keyword(s):  
Geographic Origin ◽  
Median Number ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Quality Research ◽  
Level Ii ◽  
Ankle Surgery ◽  
Ankle Research ◽  
Quality Of Research

Category: Other Introduction/Purpose: As the field of foot and ankle surgery grows and new innovations continue to be made it is important that the quality of research improves. This will help to lay a strong foundation for current and future surgeons in the field. Leading journals need to set the tone for all orthopedic journals by publishing quality literature. This current study will look at all foot and ankle articles published by JBJS[A] over a 15-year period and analyze authorship, article type, geographic origin of articles, and level of evidence trends. This study will give a representative view of where foot and ankle research is currently and where it can go as we enter the new decade. Methods: A foot and ankle research fellow reviewed all of the articles published in JBJS[A] from January 2004 to December of 2018. Articles that related to foot and ankle topics were then selected to analyzed. Editorials, letters to the editor, announcements, technical notes, retraction notes, events, errata, retracted manuscripts, historical papers and pediatric foot and ankle articles were excluded. After exclusions were applied 321 and information pertaining to each article was analyzed. Additionally, a Google Scholar search was conducted for each article to determine the number of times an article had been cited. For calculations relating to median number of citations for each article we excluded articles that were published less than three years ago (2017 and 2018). For level of evidence a kappa value (0.82) was calculated to measure interobserver reliability between two reviewers. Results: We found the following results to be significant. Clinical therapeutic studies were the predominant study design over 15 years. The amount of literature over ankle arthroplasty has increased more than any other article topic. The amount of level IV and V evidence has decreased and the amount of level II and III evidence has increased. The median number of authors has been increasing. This includes female authorship. There has been in an increase in MD, PhDs as last authors. There is more foot and ankle research being produced by Asian countries. A majority of high level of evidence articles (level I and II) comes from North America and Europe. Level of evidence doesn’t correlate with the amount of times an article is cited. Conclusion: As the field of foot and ankle surgery continues to grow it is important that there is a high quality of research being conducted and published to guide surgical and clinical decisions. Our study shows that research is being produced more globally and the number of individuals involved in the research process is increasing and diversifying. This has led to higher quality research being produced (more level II and III) and a decrease in lower quality research (IV and V). Overall, the standard of research has increased in JBJS[A] which benefits the foot and ankle surgery community. [Table: see text]

scholarly journals Opioid Consumption Rate After Foot and Ankle Surgery

2019 ◽  
Vol 4 (2) ◽  
pp. 2473011419S0000
Author(s):  
Peter Kvarda ◽  
Noortje Hagemeijer ◽  
Gregory R. Waryasz ◽  
Daniel Guss ◽  
Christopher W. DiGiovanni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Pain ◽  
Soft Tissue ◽  
Consumption Rate ◽  
Opioid Consumption ◽  
Foot And Ankle ◽  
Soft Tissue Procedure ◽  
Ankle Surgery ◽  
Ed Visits ◽  
Telephone Calls

Category: Opioid consumption rate and risk factors investigation after foot and ankle surgery Introduction/Purpose: The rapid increase in the consumption of prescription opioids has become one of the leading medical, economical, and sociological burdens in North America. In the United States, orthopedic surgery is the fourth leading specialty in the number of opioids prescribed, and the largest among surgical specialties. There is insufficient evidence to guide surgeons about appropriate opioid prescription amounts after orthopaedic foot and ankle (F&A) procedures. The aim of this study was to determine the opioid consumption rate after foot and ankle procedures, and to identify patient risk factors associated with higher use. Methods: A total of 535 patients who underwent a F&A surgery performed by one orthopedic surgeon from August 2016 to March 2018 were investigated. The study was approved by our IRB. Each patient received a preoperative discussion about postoperative pain and expectations alongside a standardized handout. At the two-week postoperative visit, the patient-reported amount of consumed opioids was recorded. Prescription details, the amount of opioids taken, refill requests, pain-issue related telephone calls, and additional MD/ED visits were also documented. Patient demographics and co-morbidities, use of regional anesthesia, postoperative inpatient hospitalization, surgery type and severity, and pre-operative opioid use were collected retrospectively. Total amounts of morphine equivalents were calculated and converted into oxycodone 5 mg pills for standardization. P-values of <0.05 were considered significant. Results: Two hundred forty-four patients with a mean age of 50 years (±16.3) and a BMI of 29 (±6.1) were included. Sixty-six (27%) patients underwent a soft tissue procedure alone and 178 (73%) underwent a bony procedure. 225 (92.2%) patients received regional block. Patients reported that they consumed only 51.2% of prescribed pills after a bony procedure and 42.4% after a soft tissue procedure, respectively, which resulted in a total of 4,496.2 left over pills that derived from this study amongst only 244 patients enrolled. There were 11 refill requests (4.5%), two (0.8%) additional MD/ED visits, and 19 (7.8%) telephone calls related to pain. BMI, procedure type, and number of opioids prescribed were positively correlated with the consumption rate (P =.002, P<.001, P<0.001, respectively). Conclusion: BMI, surgery type (bony vs. soft tissue), and a higher number of pills dispensed were correlated with higher use in the postoperative period. After an educative discussion on postoperative pain, patients took 42.4% of the prescribed opioid after soft tissue procedures and 51.2% after bony procedures, resulting in a significant number of unused pills now available to the community. Future guidelines are necessary to improve our postoperative pain management, but this study suggests that current amounts of dispensed pills after orthopaedic F&A procedures are approximately twice as high as necessary.

scholarly journals Does Postoperative Gabapentin Administration Reduce Opioid Consumption after Foot and Ankle Surgery?

2020 ◽  
Vol 5 (2) ◽  
pp. 2473011420S0001
Author(s):  
Haley McKissack ◽  
Jun Kit He ◽  
Sameer Naranje ◽  
Joshua L. Washington ◽  
Romil K. Patel ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Postoperative Period ◽  
Retrospective Chart Review ◽  
Opioid Consumption ◽  
Foot And Ankle ◽  
Medication Information ◽  
Consumption Reduction ◽  
Ankle Surgery ◽  
Dose Number ◽  
Prescription Dose

Category: Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Prescription opioids are commonly used to control postoperative pain in foot and ankle surgery, but present potentially detrimental side effects including sedation, respiratory depression, and addiction. In foot and ankle surgery, pain is a common cause of delayed hospital discharge and decreased willingness to move, thereby slowing recovery. Gabapentin acts by decreasing lesion-induced hyperexcitability of posterior horn neurons and central sensitization, and has been explored as a potential addition to patients’ pain regimen. Although studies have previously assessed the effect of gabapentin on pain relief, to our knowledge none have evaluated whether gabapentin is effective in opioid consumption reduction beyond the immediate postoperative period. The purpose of this study is to assess whether gabapentin acts synergistically to improve postoperative pain among patients undergoing foot and ankle surgery. Methods: Patients from a single institution who underwent elective foot and ankle surgery were identified using CPT codes 27700, 27702, 27870, 28705, 28715, 28725, 28730, and 28740. All patients prescribed opioids postoperatively were included. A retrospective chart review was conducted for each patient to identify prescription dose, number of pills, date in which prescription was filled, and dates of refills for oxycodone, hydrocodone, oxycodone-acetaminophen, hydrocodone-acetaminophen, tramadol, and gabapentin. Medication information was collected only for prescriptions by the operating surgeon, nurse practitioner, physician assistant, resident, or fellow which were pertinent to the foot/ankle surgery performed; prescriptions from other services or providers were not included in order to ensure that the medications prescribed were specific to postoperative pain. Opioid quantities were converted to morphine equivalents and compared at various time intervals between patients who were prescribed only opioids, and patients who were prescribed opioids and gabapentin. Results: Among patients not taking opioids or gabapentin preoperatively, total morphine equivalents prescribed was significantly less among patients prescribed postoperative gabapentin (177.3 OME) in comparison to those prescribed only opioids (442.2 OME) (p=0.0018) in the 3-6 week postoperative interval. When all patients were analyzed, including those taking preoperative opioids or gabapentin, patients who received postoperative gabapentin were also prescribed significantly fewer OME at weeks 1-2 (p= 0.0270), weeks 3-6 (p = 0.0006), and weeks 7 - 12 (p = 0.0149). Conclusion: Gabapentin may be effective in reducing postoperative opioid consumption beyond the immediate postoperative period among elective foot and ankle surgery patients. Prospective clinical trials are warranted to further validate these results. [Table: see text][Table: see text][Table: see text]

Sign in / Sign up

Export Citation Format

Share Document