Opioid Crisis and Acute Pain Management After Foot and Ankle Surgery

Bowlby, Melinda A.; Crawford, Mary

doi:10.1016/j.cpm.2019.06.009

Cited by 6 publications

(7 citation statements)

References 32 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%

“…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%

“…This can most likely be attributed to the opioid prescription concerns raised by the majority of panellists (Table 6). The addictive potential and side‐effect profile associated with opioids are widely recognised in the literature; consequently, the increase in accidental death and high health care costs reported with opioid abuse has created a need for alternative methods of pain control, as well as legislation restricting opioid prescriptions [7, 23, 29, 32].…”

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].…”

Section: Multimodal Analgesia For Acute Postoperative Painmentioning

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%

Section: Discussionmentioning

confidence: 99%

Section: Multimodal Analgesia For Acute Postoperative Painmentioning

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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“…Hindfoot arthrodesis constitutes major foot and ankle reconstruction to correct joint degeneration and deformity, typically resulting in substantial pain that may affect optimal recovery. 3,4 Consequently, patient functional outcomes and satisfaction are influenced not only by the final operative outcome but also perioperative and postoperative pain management. 7,8,14…”

Section: Introductionmentioning

confidence: 99%

Local Ketorolac Injection vs Popliteal Sciatic Nerve Blockade as an Adjuvant to a Spinal Block in Hindfoot Arthrodesis

et al. 2020

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Background: Popliteal nerve blocks reduce pain and markedly improve postoperative outcomes during foot and ankle surgery; however, several potential complications may arise from nerve block procedures. The purpose of this study was to investigate local infiltration analgesia with ketorolac as a convenient alternative for pain relief. Methods: A total of 80 patients scheduled for hindfoot arthrodesis were randomly allocated to one of 2 anesthetic groups: a spinal block augmented with either a popliteal nerve block (n = 40) or local ketorolac and Marcaine infiltration (n = 40). Clinical assessment included postoperative visual analog scale (VAS) pain scores at 4, 8, 12, 24, and 48 hours, total morphine consumption, time to incision (time in operating room to incision), operative time, length of hospital stay, and complications. Results: Despite similar morphine consumption between groups ( P = .28), VAS scores were significantly lower at 24 hours (1.6 ± 2.2 cm vs 2.7 ± 3.0 cm, P = .01) and 48 hours (0.2 ± 0.7 cm vs 1.0 ± 1.5 cm, P < .01) after surgery using local ketorolac injection. Although time from entry into the operating room to incision was also reduced after local ketorolac injection (19.0 ± 5.3 minutes vs 31.4 ± 14.6 minutes, P < .001), the length of operative time ( P = .38), hospital stay ( P = .43), and number of complications ( P = .24) were similar between groups. Conclusion: Ketorolac local injection provided effective pain control in hindfoot arthrodesis and markedly reduced VAS pain scores up to 48 hours after surgery compared with popliteal nerve block. In addition, ketorolac local injection also reduced time in the operating room compared with popliteal nerve blockade. Level of Evidence: Level 1, randomized controlled trial.

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Strategies for Reducing Perioperative Opioid Use in Foot and Ankle Surgery

Humbyrd

2023

Orthopedic Clinics of North America

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Opioid Crisis and Acute Pain Management After Foot and Ankle Surgery

Cited by 6 publications

References 32 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

Local Ketorolac Injection vs Popliteal Sciatic Nerve Blockade as an Adjuvant to a Spinal Block in Hindfoot Arthrodesis

Strategies for Reducing Perioperative Opioid Use in Foot and Ankle Surgery

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