Extensor Mechanism Ruptures and Reruptures: Perioperative Opioid Management

Abstract

<jats:title>Abstract</jats:title><jats:p>The purpose of this study was to determine (1) the correlation between preoperative and postoperative opioid use and (2) risk factors associated with rerupture in patients undergoing open extensor mechanism repair. A retrospective review of patients who underwent operative repair of quadriceps or patellar tendon rupture was performed. Patients were classified as opioid nonusers if they had not received any opioid medications in the 3 months before surgery, or as acute users or chronic users if they received at least one opioid prescription within 1 month or 3 months preceding surgery. Clinical records were reviewed for postoperative opioid use within a year after surgery as well as rerupture rates. A total of 144 quadriceps tendon and 15 patellar tendon repairs were performed at a mean age of 56.8 ± 15.1 years and body mass index of 33.2 ± 7.1. The overall rerupture rate was 6%. Diabetes was a significant risk factor for rerupture (56 vs. 19%, p = 0.023). Chronic preoperative opioid users were more likely to continue to use opioids beyond 1 month postoperatively (p &lt; 0.001) as compared with acute or nonopioid users. Chronic preoperative opioid users (relative risk [RR]: 3.53, 95% confidence interval [CI]: 2.11–5.90) and patients with longer anesthesia time (RR: 1.39, 95% CI: 1.00–1.93) required more monthly opioid refills, whereas tourniquet use required fewer opioid refills each month (RR: 0.57, 95% CI: 0.37–0.88). Compared with patients without a rerupture, each additional prescription refill after the initial repair in the rerupture group was associated with a 22% higher risk of tendon rerupture (RR: 1.22, 95% CI: 1.07–1.39). The chronicity of preoperative opioid intake was found to have a significant effect on postoperative opioid use. This study suggests that there is a higher prevalence of rerupture in patients with prolonged opioid use postoperatively and among diabetics.</jats:p>

Cultural Competence and the Postoperative Experience: Pain Control and Rehabilitation

“…Risk factors including male sex, increased body mass index, chronic preoperative opioid use, and history of anxiety/depression have been established for opioid use in pain management and length of postoperative opioid use. 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 A prospective study of 250 patients (36 Black patients, 100 Hispanic patients, and 114 white patients) after open reduction and internal fixation of limb fractures by Ng et al. 37 found that Black and Hispanic patients received lower-dose analgesics during their hospitalization (average LOS of 4.45 days) than white patients (Black: 16 mg/day, Hispanic: 13 mg/day, white: 22 mg/day, P < .002).…”