Opioid Consumption and Time to Return to Work After Percutaneous Osteotomy in Foot Surgery

Chan, Jimmy J.; Guzman, Javier Z.; Nordio, Andrea; Chan, Jesse C.; Cirino, Carl M.; Vulcano, Ettore

doi:10.3928/01477447-20200428-01

Cited by 8 publications

(12 citation statements)

References 22 publications

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“…31 Although the latter study sets a good foundation for understanding narcotic consumption after HV correction, it does not look specifically at minimally invasive HV corrective surgery. Recently, Chan et al 6 showed that patients undergoing percutaneous foot and ankle surgeries consumed a mean of 3.3 tablets of oxycodone during the first 2 weeks, whereas no patients were taking narcotics after that time point. In their study, percutaneous surgery led to a significant reduction in postoperative narcotic consumption when compared to the reported values with open procedures.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiographic Outcomes of Percutaneous Chevron-Akin Osteotomies for the Correction of Hallux Valgus Deformity

et al. 2021

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Background: Hallux valgus is a common cause of pain and dysfunction of the foot, sometimes requiring surgical correction when conservative measures fail. Although there are many methods of correction, one of the newer techniques is minimally invasive chevron-Akin (MICA). The aim of the current study is to evaluate clinical and radiographic effectiveness of MICA and narcotic use in a large patient cohort. Methods: All patients in this retrospective study were treated by a single fellowship-trained foot and ankle orthopedic surgeon. Patient demographics were collected for all cases. Preoperative and postoperative intermetatarsal angle (IMA) and hallux valgus angle (HVA) were measured in all patients on weightbearing 3-views radiographs. The Foot Function Index (FFI) was obtained pre- and postoperatively at each visit. All patients were prescribed regular use of ibuprofen for 3 days with acetaminophen and oxycodone reserved for breakthrough pain. Use of narcotic pain medication was recorded. Results: A total of 274 feet in 248 patients were included in the study. Overall, 87.9% were female and 12.1% were male. The mean preoperative IMA and HVA were 13.4 and 29.1 degrees, respectively. The postoperative IMA and HVA were 4.9 and 8.9 degrees, respectively. The mean FFI score part A was 92 preoperatively and 43 postoperatively. Patient satisfaction was 91.6%. The mean postoperative 5 mg oxycodone pill consumption was 2.2. Conclusion: MICA is good method to correct hallux valgus deformity with low postoperative narcotic use. Level of Evidence: Level III, this is a restrospective cohort study of a single surgeon practice.

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Section: Discussionmentioning

confidence: 99%

Clinical and Radiographic Outcomes of Percutaneous Chevron-Akin Osteotomies for the Correction of Hallux Valgus Deformity

et al. 2021

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“…Prescribing opioids for acute pain management in foot and ankle surgery is highly varied and without formal recommendation. The literature has few guidelines for opioid-prescribing practices, with only anecdotal suggestions offered, and because physicians cannot accurately predict how much analgesia a patient will require, opioids tend to be overprescribed [ 9 , 10 , 15 , 23 , 29 – 31 ]. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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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“…The reduced soft tissue damage may allow faster recovery and reduced postoperative pain. 3,31 Moreover, although the risk of sural nerve damage may be reduced by the percutaneous approach, it is important to place the skin incision with a beaver blade in a safe zone far from the nerve course, spreading deeper soft tissues with a smooth instrument (eg, a mosquito clamp) before using the Shannon burr. 6,16,33 Fluoroscopy can be helpful to reduce the learning curve, as reported on forefoot percutaneous techniques.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Percutaneous Calcaneoplasty for Insertional Achilles Tendon Problems

Ferranti¹,

Migliorini

Liuni

et al. 2021

Foot Ankle Int.

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Background: Percutaneous procedures have been used recently to treat insertional Achilles tendon problems. The present study reports our results of this treatment approach. Methods: Patients undergoing percutaneous calcaneoplasty for insertional Achilles tendon problems were retrieved. Patients completed the visual analog scale (VAS) for pain and the Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaire before the operative procedure and at the last follow-up. At the last follow-up, we asked the patients whether they were completely satisfied, moderately satisfied, or unsatisfied after the procedure. Complications were also recorded. Results: A total of 27 patients were enrolled. The average follow-up was 26.5 months (range 6-68). The mean age of patients was 56.2 years (24-82). The mean VAS score before surgery was 8.1 ± 0.9 decreasing by the last follow-up to 2.4 ± 2.3 ( P < .0001). The mean VISA-A score improved from 20.7 ± 5.4 to 75.7 ± 25.5 at last follow-up, an improvement of 55% ( P < .0001). At the last follow-up, 84.5% (22 of 27) patients were completely satisfied with the procedure, 7.4% (2 of 27) moderately satisfied, and 11.1% (3 of 27) were not satisfied. These last 3 patients presented recurrence of symptoms, requiring revision surgery. Conclusion: For the selected patients, we found percutaneous calcaneoplasty to be an effective treatment for insertional Achilles tendon problems Level of Evidence: Level III, retrospective study.

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Opioid Consumption and Time to Return to Work After Percutaneous Osteotomy in Foot Surgery

Cited by 8 publications

References 22 publications

Clinical and Radiographic Outcomes of Percutaneous Chevron-Akin Osteotomies for the Correction of Hallux Valgus Deformity

Clinical and Radiographic Outcomes of Percutaneous Chevron-Akin Osteotomies for the Correction of Hallux Valgus Deformity

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

Outcomes of Percutaneous Calcaneoplasty for Insertional Achilles Tendon Problems

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