scholarly journals Is otologic surgery contributing to the opioid epidemic?

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Valerie Dahm ◽  
Justin T. Lui ◽  
Rudolfs Liepins ◽  
Joseph M. Chen ◽  
Trung N. Le ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Local Anesthetics ◽  
Pain Control ◽  
Pain Medication ◽  
Prescribing Patterns ◽  
Opioid Epidemic ◽  
Online Questionnaire ◽  
Ear Surgery ◽  
Health Crisis ◽  
Otologic Surgery

Abstract Background The opioid epidemic is a significant public health crisis challenging the lives of North Americans. Interestingly, this problem does not exist to the same extent in Europe. Surgeons play a significant role in prescribing opioids, especially in the context of post-operative pain management. The aim of this study was to compare the post-surgical prescribing patterns of otologists comparing Canada and Austria. Methods An online questionnaire was sent to 33 Canadian and 32 Austrian surgeons, who perform otologic surgery on a regular basis. Surgeons were asked to answer some questions about their background as well as typical prescribing patterns for postoperative pain medication for different ear surgeries (cochlear implant, stapedotomy, tympanoplasty). In addition, surgeons were asked about the typical use of local anesthetics for pain control at the end of a procedure. Otologists gave an estimate how confident they were that their therapy and prescriptions provide sufficient pain control to their patients. Results Analysis of the returned questionnaires showed that opioids are more commonly prescribed in Canada than in Austria. Nonsteroidal anti-inflammatory drugs are used for postoperative pain more regularly after ear surgery in Austria, as opposed to Canada. Some of the prescribed drugs by European otologists are not available in North America. The use of local anesthetics at the end of surgery is not common in Austria. Surgeons´ confidence that the prescribed pain medication was sufficient to control postoperative symptoms was higher in the group not prescribing opioids than in the group that did routinely prescribe opioids. Conclusion Prescribing patterns differ substantially between the two evaluated countries. This data suggests an opportunity to reduce opioid prescriptions after otologic surgeries. Studies to evaluate pain after these operations as well as efficacy of analgesics following ear surgery are an important next step. Graphical abstract

scholarly journals Self-Reported Pain Tolerance and Opioid Pain Medication Use after Foot and Ankle Surgery

2019 ◽  
Vol 4 (2) ◽  
pp. 2473011419S0000
Author(s):  
Laura E. Sokil ◽  
Elizabeth McDonald ◽  
Ryan G. Rogero ◽  
Daniel J. Fuchs ◽  
Steven M. Raikin ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Control ◽  
Pain Threshold ◽  
Postoperative Pain Management ◽  
Pain Medication ◽  
Pain Tolerance ◽  
Foot And Ankle ◽  
Ankle Surgery ◽  
Perceived Pain

Category: Pain Management Introduction/Purpose: The opioid epidemic in the United States continues to take lives. As one of the top prescribing groups, orthopaedic surgeons must tailor post-surgical pain control to minimize the potential for harm from prescription opioid use. Patients often reference their own pain threshold as a benchmark for how they will tolerate the pain of surgery, but current literature suggests that there is not a significant correlation between an individual’s perceived pain threshold and their actual threshold for heat stimulus. The purpose of this study was to determine whether there is a correlation between a patient’s self- reported pain tolerance and their actual prescription narcotic medication usage after foot and ankle surgery. Methods: This was a prospective cohort study of adult patients that underwent outpatient foot and ankle surgeries performed by 5 fellowship-trained foot and ankle surgeons at a large, multispecialty orthopaedic practice over a one year period. Demographic data, procedural details and anesthesia type were collected. Narcotic usage data including number of pills dispensed and pill counts performed at the first postoperative visit were obtained. Patients were contacted via email or telephone between 7-19 months postoperatively, and asked to respond to the validated statement “Pain doesn’t bother me as much as it does most people” by choosing “strongly disagree”, “disagree”, “neither”, “agree” or “strongly agree”. Patients scored their pain threshold on a scale of 1- 100 with 0 being “pain intolerant” and 100 a ”high pain threshold" and ranked their expectations of the pain after surgery and satisfaction with pain management on respective five-point Likert scales. Data was analyzed using a Spearman’s correlation. Results: Of the 486 patients who completed surveys, average age was 51.24 years, 32.1% were male and 7.82% current smokers. After controlling for age and anesthesia type, both agreement with the validated statement and higher pain tolerance score had a weak negative correlation with pills taken (r=-0.13, p=0.004 and r=-0.14, p=0.002, respectively); patients with higher perceived pain thresholds took fewer opioid pills after surgery (Table 1). Correlation between high expectations of postoperative pain and pills taken was weakly negative (r=-0.28, p=<0.001) (Table 1). Patients who found surgery more painful than they expected took less pain medication. There was a small, positive correlation between pain tolerance and satisfaction with pain management (r=0.12, p=0.008), indicating that patients with a relatively high pain tolerance had more satisfaction (Table 1). Conclusion: Assessment of both subjective description and quantitative score of a patient’s pain threshold prior to surgery may assist the surgeon in tailoring postoperative pain control regimens. Unexpectedly, patients who found surgery less painful than expected actually took a greater number of opioid pills. This may highlight an educational opportunity regarding postoperative pain management in order to reduce narcotic requirement. Setting expectations on safe utilization of prescribed pain medications may also increase satisfaction. This study provides useful information for surgeons to customize pain management regimens and to perform effective preoperative education and counseling regarding postoperative pain management. [Table: see text]

scholarly journals Local anesthesia combined with intra-articular ropivacaine can provide satisfactory pain control in ankle arthroscopic surgery: A retrospective cohort study

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902093812
Author(s):  
Mingyang An ◽  
Xiangzheng Su ◽  
Min Wei ◽  
Baiqing Zhang ◽  
Feng Gao ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Local Anesthesia ◽  
Pain Control ◽  
Retrospective Cohort ◽  
Arthroscopic Surgery ◽  
Pain Medication ◽  
Ankle Arthroscopy ◽  
Hospitalization Cost ◽  
Significant Difference ◽  
Vas Scores

Background: Local anesthesia (LA) is widely used in knee arthroscopic surgery but not in ankle arthroscopy. Objective: To understand the effectiveness and safety of LA combined with ropivacaine in pain control for ankle arthroscopy. Study Design: Retrospective cohort. Methods: We retrospectively collected data for patients who underwent ankle arthroscopy from April 2012 to April 2017. Patients were grouped by anesthesia method: LA, LA with ropivacaine (LA+R), spinal anesthesia (SA), and SA with ropivacaine (SA+R). Intra- and postoperative visual analog scale (VAS) scores, complications, doses of supplemental pain medication, hospitalization cost and duration, and satisfaction with pain control during hospitalization were analyzed. Results: The study included 276 patients (LA: 93; LA+R: 124; SA: 31; SA+R: 28). The LA and LA+R groups had significantly higher intraoperative VAS scores (LA vs. SA, p = 0.001; LA vs. SA+R, p = 0.002; LA+R vs. SA, p = 0.00; LA+R vs. SA+R, p = 0.00), but fewer complications, than the SA and SA+R groups. The LA+R and SA+R groups had significantly better outcomes for postoperative pain control (LA vs. LA+R, p = 0.01; LA vs. SA+R, p = 0.01; SA vs. SA+R, p = 0.01; SA vs. LA+R, p = 0.03) and required less supplemental pain medication. Hospitalization cost was lower and duration shorter in the LA and LA+R groups than in the SA and SA+R groups. There was no significant difference in satisfaction among the four groups. Limitations: This was a single-center retrospective and relatively short-term study. Conclusions: LA+R which could be safely applied in ankle arthroscopy provided satisfactory pain control, reduced postoperative pain intensity, fewer complications, shorter hospital stay, and good cost-effectiveness. It can be safely applied in ankle arthroscopy for the specific patients with ankle osteoarthritis.

scholarly journals Postoperative Narcotic Prescription Practice in Orthopedic Foot and Ankle Surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 247301141877594
Author(s):  
Thomas M. Hearty ◽  
Paul Butler ◽  
John Anderson ◽  
Donald Bohay
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Pain Medication ◽  
Foot And Ankle ◽  
Prescribing Practices ◽  
Nerve Blocks ◽  
Opioid Prescription ◽  
Health Crisis ◽  
Ankle Surgery

Background: The misuse and abuse of opioid pain medications have become a public health crisis. Because orthopedic surgeons are the third highest prescribers of opioids, understanding their postoperative pain medication prescribing practices is key to solving the opioid crisis. To this end, we conducted a study of the variability in orthopedic foot and ankle surgery postoperative opioid prescribing practice patterns. Methods: Three hundred fifty orthopedic foot and ankle surgeons were contacted; respondents completed a survey with 4 common patient scenarios and surgical procedures followed by questions regarding typical postoperative pain medication prescriptions. The scenarios ranged from minimally painful procedures to those that would be expected to be significantly more painful. Summaries were calculated as percentages and chi-square or Fisher exact tests were used to compare survey responses between groups stratified by years in practice and type of practice. Results: Sixty-four surgeons responded to the survey (92.8% male), 31% were in practice less than 5 years, 34% 6 to 15 years and 34% more than 15 years. For each scenario, there was variation in the type of pain medication prescribed ( scenario 1: 17% 5 mg hydrocodone, 22% 10 mg hydrocodone, 52% oxycodone, and 3% oxycodone sustained release [SR]; scenario 2: 15% 5 mg hydrocodone, 13% 10 mg hydrocodone, 58% oxycodone, and 9% oxycodone SR; scenario 3: 11% 5 mg hydrocodone, 13% 10 mg hydrocodone, 56% oxycodone, and 14.1% oxycodone SR; scenario 4: 3% 5 mg hydrocodone, 5% 10 mg hydrocodone, 44% oxycodone, and 45% oxycodone SR) and the number of pills dispensed. Use of multimodal pain management was variable but most physicians use regional nerve blocks for each scenario (76%, 87%, 69%, 94%). Less experienced surgeons (less than 5 years in practice) supplement with tramadol more for scenario 1 ( P = .034) as well as use regional nerve blocks for scenario 2 ( P = .039) more than experienced surgeons (more than 15 years in practice). Conclusion: It is evident that variation exists in narcotic prescription practices for postoperative pain management by orthopedic foot and ankle surgeons. With new AAOS guidelines, it is important to try to create some standardization in opioid prescription protocols.

scholarly journals How Will the Foot and Ankle Orthopedic Community Respond to the Growing Opioid Epidemic?

2018 ◽  
Vol 3 (3) ◽  
pp. 247301141876446 ◽  
Author(s):  
Gabrielle S. Donahue ◽  
Noortje Catherine Hagemeijer ◽  
Anne Holly Johnson
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Orthopedic Surgery ◽  
Clinical Guidelines ◽  
Postoperative Pain Management ◽  
Consumption Patterns ◽  
Prescribing Patterns ◽  
Opioid Epidemic ◽  
Foot And Ankle ◽  
Ankle Surgery

In the midst of the current opioid crisis, it has become critically important to properly manage opioid-prescribing patterns for the treatment of postoperative pain. There is currently a scarcity of literature specifying prescription and consumption patterns following orthopedic surgery and specifically foot and ankle surgery. Clinical guidelines for postoperative pain management are deficient.

scholarly journals Pain Management following Open Reduction and Internal Fixation (ORIF) of Distal Radius Fractures

2020 ◽  
Author(s):  
Steven R. Niedermeier ◽  
Nisha Crouser ◽  
Krystin Hidden ◽  
Sonu A. Jain
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Internal Fixation ◽  
Distal Radius ◽  
Pain Control ◽  
Open Reduction ◽  
Pain Medication ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Significant Difference

Abstract Background Distal radius fractures (DRF) are commonly treated with open reduction and internal fixation (ORIF). Few studies address perioperative and postoperative pain control for this procedure. Questions/Purpose We attempt to demonstrate efficacy of pain management modalities during the perioperative and acute postoperative period after ORIF. Specifically, does the type of perioperative anesthesia used during fixation of DRF affect pain control postoperatively? Does the quantity of narcotic pain medication prescribed or type of pain medication given postoperatively affect pain management? Methods We retrospectively reviewed 294 adult (≥18 years old) patients who underwent outpatient ORIF of acute DRF between December 2012 and December 2014. All procedures were performed with a standard volar plating technique through a flexor carpi radialis approach. Patient demographics, fracture laterality, severity of fracture, type of operative anesthesia, and details regarding postoperative oral pain medications were recorded. We reviewed the number and timing of patient phone calls regarding postoperative pain and refills of pain prescriptions. Results Two-hundred ninety-four patients (average age 48.7 years) were included. One-hundred twenty-two injuries were right-sided (41.5%), 168 were left-sided (57.1%), and four were bilateral (1.4%). One-hundred fifty-one patients (51.4%) received regional anesthesia prior to surgery. Average number of narcotics tablets prescribed was 58. There were 66 patients who called the orthopaedic patient hotline regarding pain-control issues at a median of 7.0 days postoperatively. One-hundred twenty-nine (43.9%) patients required refills of narcotic pain medication postoperatively. There was no significant difference in the number of calls or refills given with regard to the type of anesthesia used or postoperative pain regimen prescribed. Conclusions More than one-fifth of patients who underwent ORIF experienced pain severe enough to call our institution's orthopaedic hotline to ask for help at a median of 7 days after fixation. Clinical Relevance Our study demonstrates poor pain control regardless of intraoperative anesthesia or utilization of varying postoperative pain regimens.

Assessment of Pain and Analgesic Use in Children Following Otologic Surgery

2020 ◽  
pp. 019459982097118
Author(s):  
Liliya Benchetrit ◽  
Megan Kwock ◽  
Evette Ronner ◽  
Sheli Goldstein ◽  
Edina Shu ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Tertiary Care ◽  
Case Series ◽  
Endoscopic Ear Surgery ◽  
Ear Surgery ◽  
Otologic Surgery ◽  
Pain Ratings ◽  
The Mean ◽  
Analgesic Use

Objective To compare postoperative pain and analgesic use in children following transcanal endoscopic ear surgery (TEES) vs non–transcanal endoscopic ear surgery (non-TEES). Study Design Prospective case series. Setting Tertiary care center. Methods Surveys using the Wong-Baker FACES Pain Rating Scale and recording the frequency and dosage of consumed analgesics were administered prospectively to caregivers of children undergoing otologic surgery between May 2018 to February 2020. Pain intensity and medication use were recorded twice daily for 6 days, starting on postoperative day 0. Mean pain scores and mean number of consumed analgesic doses were compared between groups. Results Survey response rate was 57.9%. Among 53 patients who completed the survey, 35 (66.0%) underwent TEES and 18 (34.0%) underwent non-TEES. Mean pain ratings on postoperative days 0 and 1 were significantly lower among children undergoing TEES (2.2 and 2.1) vs non-TEES (4.0 and 4.1), P = .045 and P = .008, respectively (Mann-Whitney U test). The mean pain ratings across the 6 days were similar in TEES (1.7) and non-TEES (2.6) ( P = .140, Mann-Whitney U test). The mean number of analgesic doses consumed per half-day over the 6 days was significantly lower among children undergoing TEES (0.3) vs non-TEES (0.6; P = .049, Mann-Whitney U test). Conclusion Postoperative pain following TEES and non-TEES in children was overall low. Children undergoing TEES had a small but statistically significant decrease in pain on postoperative days 0 and 1 and decreased use of pain medications compared to non-TEES.

scholarly journals Local anesthetics: pharmacological bases for its use in postoperative pain control

Revista Dor ◽  
2017 ◽  
Vol 18 ◽  
Author(s):  
Gustavo Rodrigues Costa Lages ◽  
Érica Carla Lage de Oliveira ◽  
Rafael Neder Issa Fortuna
Keyword(s):  
Postoperative Pain ◽  
Local Anesthetics ◽  
Pain Control ◽  
Postoperative Pain Control

Written Prescription for Over-the-Counter Nonopioid Pain Medications Does Not Increase the Likelihood of Use after Ambulatory Hand and Upper Extremity Surgery

2020 ◽  
Author(s):  
Daniel J. Lynch ◽  
James S. Lin ◽  
Kanu S. Goyal
Keyword(s):  
Postoperative Pain ◽  
Soft Tissue ◽  
Upper Extremity ◽  
Pain Control ◽  
Control Program ◽  
Postoperative Pain Control ◽  
Over The Counter ◽  
Unequal Variance ◽  
Pain Medications ◽  
Medication Consumption

Abstract Introduction This study looked to determine how providing written prescriptions of nonopioids affected postoperative pain medication usage and pain control. Materials and Methods Patients undergoing hand and upper-extremity surgery (n = 244) were recruited after the implementation of a postoperative pain control program encouraging nonopioids before opioids. Patients were grouped based on procedure type: bone (n = 66) or soft tissue (n = 178). Patients reported postoperative medication consumption and pain control scores. Two-tailed t-tests assuming unequal variance were performed to look for differences in postoperative pain control and medication consumption between those who were and were not given written prescriptions for nonopioids. Results For both soft tissue and bone procedure patients, a written prescription did not significantly affect patients’ postoperative pain control or medication consumption. Regardless of receiving a written prescription, patients who underwent soft tissue procedures consumed significantly more daily nonopioids than opioids. Conclusion Receiving written prescriptions for nonopioids may not have a significant effect on postoperative pain control or medication consumption. Patients undergoing soft tissue hand and upper extremity procedures may be more likely to consume more daily nonopioids than opioids postoperatively compared to bone procedure patients regardless of whether they receive a written prescription for nonopioids.

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