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

Bhashyam, Abhiram R.; Keyser, Cornelia; Miller, Christopher P.; Jacobs, Jennifer; Bluman, Eric M.; Smith, Jeremy T.; Chiodo, Christopher P.

doi:10.1177/1071100719863711

Cited by 19 publications

(21 citation statements)

References 27 publications

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“…Similarly, this study had a lack of a definitive consensus on prescribing opioid analgesics for moderate acute postoperative pain, however, the consensus to use opioids at more severe pain levels in this study is reflective of the literature. These include a level II prospective observational cohort study that proposed patients who had hindfoot, ankle, or osseous procedures required more opioids [ 9 ], as well as the study by Chan et al that found fewer opioids were required postoperatively for percutaneous foot and ankle surgery due to the smaller incisions and minimal disruption to surrounding soft tissue [ 31 ].…”

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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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%

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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“…Our patients, closely following the postoperative protocol did not need to resort to opioid use, which is reported to be greater in chronic pain patients due to tolerance, dependence and opioid-induced hyperalgesia [ 59 ]. For these reasons, orthopaedic surgeons should be aware that long-term postoperative opioid use must be avoided [ 59 ], as its inadvertent overprescription may place patients and their communities at risk of abuse or OUD [ 58 , 60 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of chronic pain syndrome in patients who have undergone hallux valgus percutaneous surgery: a comparison of sciatic-femoral and ankle regional ultrasound-guided nerve blocks

Biz

Iudicibus

Belluzzi

et al. 2021

BMC Musculoskelet Disord

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Background Chronic pain syndrome (CPS) is a common complication after operative procedures, and only a few studies have focused on the evaluation of CPS in foot-forefoot surgery and specifically on HV percutaneous correction. The objective of this study was to compare postoperative pain levels and incidence of CPS in two groups of patients having undergone femoral-sciatic nerve block or ankle block regional anaesthesia before hallux valgus (HV) percutaneous surgery and the association between postoperative pain levels and risk factors between these patient groups. Methods A consecutive patient series was enrolled and evaluated prospectively at 7 days, 1, 3 and 6 months after surgery. The participants were divided into two groups according to the regional anaesthesia received, femoral-sciatic nerve block or ankle block, and their outcomes were compared. The parameters assessed were postoperative pain at rest and during movement by the numerical rating scale (NRS), patient satisfaction using the Visual Analogue Scale (VAS), quality of life and return to daily activities. Statistical analysis was performed. Results One hundred fifty-five patients were assessed, 127 females and 28 males. Pain at rest (p < 0.0001) and during movement (p < 0.0001) significantly decreased during the follow-ups; at 6 months, 13 patients suffered from CPS. Over time, satisfaction remained stable (p > 0.05), quality of life significantly increased and patients returned to daily activities and work (p < 0.0001). No significant impact of type of anaesthesia could be detected. ASA 3 (p = 0.043) was associated to higher pain during movement; BMI (p = 0.005) and lumbago (p = 0.004) to lower satisfaction. No operative-anaesthetic complications were recorded. Postoperative pain at rest and during movement improved over time independently of the regional block used, with low incidence of CPS at last follow-up. Among risk factors, only a higher ASA was associated to higher pain during movement, while higher BMI and lumbago to lower satisfaction. Conclusions Both ultrasound-guided sciatic-femoral and ankle blocks were safe and effective in reducing postoperative pain with low incidence of CPS at last follow-up. Trial registration Clinical Trial NCT02886221. Registered 1 September 2016.

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“…12 14 Additionally, almost half of the prescribed opioid pills are not used which are at risk of misuse. 12 24 25 26 27 To address this, 32 States in the United States have enforced legislation which limits opioid prescriptions to a 7-day supply or less. However, further prescription guidelines are needed to optimize pain management: creating parameters based on specific patient characteristics along with patient education in a multidisciplinary approach.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Opioid Use Following Surgery for Symptomatic Neuroma

Lans

Westenberg

Gottlieb

et al. 2021

J Reconstr Microsurg

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Background Identifying patients at risk for prolonged opioid use following surgery for symptomatic neuroma would be beneficial for perioperative management. The aim of this study is to identify the factors associated with postoperative opioid use of >4 weeks in patients undergoing neuroma surgery. Methods After retrospective identification, 77 patients who underwent surgery for symptomatic neuroma of the upper or lower extremity were enrolled. Patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) depression, Numeric Rating Scale (NRS) pain score, and a custom medication questionnaire at a median of 9.7 years (range: 2.5–16.8 years) following surgery. Neuroma excision followed by nerve implantation (n = 39, 51%), nerve reconstruction/repair (n = 18, 23%), and excision alone (n = 16, 21%) were the most common surgical treatments. Results Overall, 27% (n = 21) of patients reported opioid use of more than 4 weeks postoperatively. Twenty-three patients (30%) reported preoperative opioid use of which 11 (48%) did not report opioid use for >4 weeks, postoperatively. In multivariable logistic regression, preoperative opioid use was independently associated with opioid use of >4 weeks, postoperatively (odds ratio [OR] = 4.4, 95% confidence interval [CI]: 1.36–14.3, p = 0.013). Conclusion Neuroma surgery reduces opioid use in many patients but patients who are taking opioids preoperatively are at risk for longer opioid use. Almost one-third of patients reported opioid use longer than 4 weeks, postoperatively.

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

Cited by 19 publications

References 27 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

Prevalence of chronic pain syndrome in patients who have undergone hallux valgus percutaneous surgery: a comparison of sciatic-femoral and ankle regional ultrasound-guided nerve blocks

Long-Term Opioid Use Following Surgery for Symptomatic Neuroma

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