Multimodal Analgesia in Foot and Ankle Surgery

Kohring, Jessica M.; Orgain, Nathan G.

doi:10.1016/j.ocl.2017.06.005

Cited by 25 publications

(29 citation statements)

References 65 publications

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“…It is widely accepted that acute postoperative pain management should employ a multimodal approach, but there is little consensus with regards to the specific combinations of analgesics used in specific situations [ 12 ]. Multimodal treatment has been shown to provide superior pain relief, and a reduction in opioid dependence and opioid related adverse events [ 5 , 7 , 12 , 23 , 24 ]. The combined drug synergy effects that block generation and perception of pain at several different stages in the pain pathway has been reported to be necessary for effective pain control [ 7 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Multimodal treatment has been shown to provide superior pain relief, and a reduction in opioid dependence and opioid related adverse events [ 5 , 7 , 12 , 23 , 24 ]. The combined drug synergy effects that block generation and perception of pain at several different stages in the pain pathway has been reported to be necessary for effective pain control [ 7 , 12 ]. Several studies have reported on optimal pain management strategies through multimodal analgesia for elective foot and ankle surgeries with the use of the paracetamol, NSAIDs, opioids, and α2δ-ligands, and regional anaesthesia [ 5 , 7 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Acute postoperative pain management protocols in podiatric surgery within Australia: a Delphi study

Ang

Hugo

Silvester

2022

Journal of Foot and Ankle Research

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Background There is limited evidence in the literature to describe an analgesic protocol that takes into consideration the extent of foot and ankle surgery. The aim of this study was to develop a guide for acute postoperative pain management for podiatric surgery in Australia, and to identify opportunities to improve the current list of scheduled medicines available to podiatric surgeons. Methods A Delphi method involving 3 survey rounds was employed for this study. Twelve expert panellists in the field of podiatric surgery and anaesthesiology were invited to participate, and 10 panellists remained by the end of the study. Round 1 involved 15 open-ended questions. These answers formed the basis of the 55 statements that were developed for the following 2 survey rounds, where panellists rated the appropriateness of each statement on a 9-point Likert scale. The third survey round was an opportunity for panellists to revise their answers to each statement in light of the majority response. Results For mild acute postoperative pain, non-opioid oral analgesics were recommended as an appropriate management option. For moderate and severe acute postoperative pain, both non-opioid and opioid products were found to be appropriate by the majority. It was agreed that oral opioids be reserved for breakthrough pain at all severity levels. All other statements in the Delphi study pertaining to drug hypersensitivities or allergies, stratification of pain management, opioid prescription concerns, and access to pain medications were accepted as appropriate by the majority of panellists. Conclusion The agreed approach to acute postoperative pain management for podiatric surgeons in Australia was with a stepwise approach, utilising multimodal therapy, and reserving oral opioids for breakthrough pain. Additionally, there was consensus for podiatric surgeons in Australia to have wider access to alternative analgesics and anti-emetics that have similar or improved efficacies with better safety profiles.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute postoperative pain management protocols in podiatric surgery within Australia: a Delphi study

Ang

Hugo

Silvester

2022

Journal of Foot and Ankle Research

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“…Additionally, patients received multimodal pain medications, which has been shown to greatly improve postoperative analgesia in foot and ankle surgery. 28,32,47 At present, in our practice, in addition to receiving a regional nerve block when indicated, patients are also given multimodal pain medications. These include a narcotic pain medication (typically oxycodone 5 mg every 4 hours as needed for pain), scheduled acetaminophen (1000 mg every 6-8 hours), gabapentin (300 mg at bedtime), and ondansetron 8 mg as needed for nausea.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Single-Agent Versus 3-Additive Regional Anesthesia for Foot and Ankle Surgery

Dang

McGarry

Melbihess³

et al. 2019

Foot Ankle Int.

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Background: This study compared the results of regional blocks containing a single anesthetic, bupivacaine, with those containing bupivacaine and 3 additives (buprenorphine, clonidine, and dexamethasone) in patients undergoing foot and ankle surgery. Methods: Eighty patients undergoing foot and ankle surgery over a 9-month period were prospectively enrolled and randomized to receive a peripheral nerve block containing either a single anesthetic (SA) or one with 3 additives (TA). Patients, surgeons, and anesthesiologists were blinded to the groups. Patients maintained pain diaries and were evaluated at 1 and 12 weeks postoperatively. Fifty-six patients completed the study. Results: The TA group had a longer duration of analgesic effect than the SA group (average 82 vs 34 hours, P < .05). Forty-eight hours after surgery, 93% of SA blocks, compared with 34% of TA blocks, had completely worn off. The TA group had a longer duration of sensory effects. At 3 months, 10 of 26 (38.5%) TA patients, compared with 3 of 30 (10%) SA patients, reported postoperative neurologic symptoms. Pain scores in both groups were not statistically different at 1 week or 3 months after surgery. Patients in both groups were similarly satisfied with their blocks. Conclusion: Both types of nerve blocks provided equivalent pain control and patient satisfaction in patients undergoing foot and ankle surgery. The 3-additive agent blocks were associated with a longer duration of pain relief and a longer duration of numbness, as well as higher rates of postoperative neurologic symptoms. Longer pain relief may be obtained at the cost of prolonged sensory deficits. Level of Evidence: Level II, prospective comparative study.

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“…[ 3 , 5 , 7 ] The multimodal analgesia addresses multiple pain mechanisms and improves postoperative pain by combining pharmacologic and other modalities while reducing adverse effects using lower doses of individual modalities. [ 12 – 14 ] There is no immutable and standard protocol for multimodal analgesia. Multiple pathways and mediators are involved in nociception, and targeting several mechanisms can increase analgesic efficacy, using combinations of systemic and regional anesthesia.…”

Section: Introductionmentioning

confidence: 99%

“…Various medications have been used in multimodal therapy, including nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX)-2 inhibitors, acetaminophen, or paracetamol, neuromodulatory medications (gabapentin and pregabalin), opioid agonists, steroids, and N-methyl D-aspartate (NMDA) antagonists. [ 14 ]…”

Section: Introductionmentioning

confidence: 99%

Analgesic effect of perioperative ketamine for total hip arthroplasties and total knee arthroplasties

Wang¹,

Shan³

et al. 2020

Medicine

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Background: Total hip arthroplasties (THA) and total knee arthroplasties (TKA) are always associated with a frequent incidence of postoperative pain. Effective pain management after surgery is quite essential for surgeons and patients. The purpose of the present meta-analysis is to evaluate the analgesic effect of perioperative ketamine after THA and TKA. Methods: Seven online databases, Embase, Cochrane Library, Pubmed, Web of Science, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), and Wanfang Data were searched for the related randomized controlled trials (RCT) by August 15, 2019. The qualities of the included studies were assessed based on the Cochrane Handbook for Systematic Reviews of Interventions 5.0 . The visual analog scale (VAS), morphine equivalent consumption, and the side effects were used to evaluate the postoperative analgesic effect of ketamine by meta-analysis, which was performed by Review Manager version 5.3 software. Results: The VAS scores at 6 hours, 12 hours, 24 hours, and 48 hours after surgery were statistically lower in the ketamine group. The morphine equivalent consumptions in 24 hours and 48 hours after surgery were also significantly lower in the ketamine group. For the side effects, no statistical differences in odds ratio (OR) of sedation, dizziness, hallucination, sweating, pruritus, urinary retention, constipation, version trouble, nightmares, and delirium were observed between the ketamine group and the control group. But postoperative nausea and vomiting (PONV) showed lower OR in the ketamine group. Conclusion: The present meta-analysis demonstrated perioperative ketamine could be used as a safe and effective analgesic agent for THA and TKA.

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Multimodal Analgesia in Foot and Ankle Surgery

Cited by 25 publications

References 65 publications

Acute postoperative pain management protocols in podiatric surgery within Australia: a Delphi study

Acute postoperative pain management protocols in podiatric surgery within Australia: a Delphi study

Comparison of Single-Agent Versus 3-Additive Regional Anesthesia for Foot and Ankle Surgery

Analgesic effect of perioperative ketamine for total hip arthroplasties and total knee arthroplasties

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