Perioperative pain management and chronic postsurgical pain after elective foot and ankle surgery: a scoping review

Stiegelmar, C; Li, Yibo; Beaupré, Lauren A; Pedersen, M. Elizabeth; Dillane, Derek; Funabashi, Martha

doi:10.1007/s12630-019-01370-3

Cited by 7 publications

(6 citation statements)

References 38 publications

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“…Foot surgery often causes serious and prolonged postoperative pain [ 19 ]. The primary aim of this study was to explore an effective method of analgesia for patients with unilateral calcaneal fractures.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture: a randomized clinical trial

Zhang

Wang

et al. 2021

BMC Musculoskelet Disord

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Objectives The aim of this study was to evaluate the postoperative analgesia effect of ultrasound-guided single popliteal sciatic nerve block for calcaneal fracture. Methods A total of 120 patients scheduled for unilateral open reduction and internal fixation of calcaneal fracture were enrolled in this prospective randomized study. Patients in group B received ultrasound-guided single popliteal sciatic nerve block after operation, but Patients in group A did not. All patients received patient-controlled intravenous analgesia (PCIA) after operation. The time to initiation of PCIA, the time of first pressing the analgesia pump, duration of analgesia pump use and the total number of times the patient pressed the analgesia pump were recorded. The time of rescue analgesia and the adverse reactions were recorded. Pain magnitude of the patients immediately after discharge from operating room (T1), and at 4th (T2), 8th (T3), 12th (T4), 16th (T5), 24th (T6) and 48th (T7) h after the operation were assessed with visual analog scale (VAS). In addition, patient, surgeon and nurse satisfaction were recorded. Results The VAS scores at T2 ~ T5, the time of rescue analgesia and the adverse reactions, the total number of times the patient pressed the analgesia pump were significantly declined in group B (p < 0.001). The time to initiation of PCIA, the time of first pressing the analgesia pump, duration of analgesia pump use were prolonged and patient surgeon and nurse satisfaction were improved in group B (p < 0.05). Conclusion Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture. Trial registration ChiCTR, ChiCTR2100042340. Registered 19 January 2021, URL of trial registry record: http://www.chictr.org.cn/showproj.aspx?proj=66526.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture: a randomized clinical trial

Zhang

Wang

et al. 2021

BMC Musculoskelet Disord

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“…Postoperative pain after major elective ankle and hindfoot surgery (ankle arthrodesis, subtalar arthrodesis, triple arthrodesis) is often severe for several days—especially the first two postoperative days 1,3,4,6. Daily mean in‐hospital opioid consumption has been reported at ranges of approximately 10–30 mg oral morphine‐equivalent doses15 (with much higher doses in intermittent or long‐term preoperative opioid users), despite multimodal analgesic regimes including single‐dose PNB or cPNB 6,9,16. Either single‐dose PNB or cPNB is conventionally recommended as a component of multimodal analgesia in order to alleviate postoperative pain after major ankle and hindfoot surgery 4.…”

Section: Discussionmentioning

confidence: 99%

“…Focus on optimal postoperative pain management may also be paramount for the reduction of chronic postsurgical pain since clinical studies have shown a strong association between acute and chronic postsurgical pain 4,16,31. The incidence of chronic postsurgical pain is 10%–50% and may be much higher in specific populations of patients—for example, post‐amputation 31.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of chronic postsurgical pain is 10%–50% and may be much higher in specific populations of patients—for example, post‐amputation 31. One year following major elective ankle and hindfoot surgery, moderate to severe pain may be as high as 21% at rest and 43% while walking 4,16,32. It remains to be clarified whether the observed association between severe acute and chronic pain is due to non‐causal confounding or causation.…”

Section: Discussionmentioning

confidence: 99%

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Pain relief after major ankle and hindfoot surgery with repetitive peripheral nerve blocks: A feasibility study

Hannig

Hauritz

Bjørn

et al. 2023

Acta Anaesthesiol Scand

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BackgroundMajor ankle and hindfoot surgery (e.g., ankle, triple and subtalar arthrodesis) typically causes severe postoperative pain, especially the first two postoperative days. Current modalities of postoperative analgesic treatment often include continuous peripheral nerve blocks of the saphenous and sciatic nerves via catheters in order to extend the duration of pain‐ and opioid‐free nerve blockade to 48 h. Unfortunately, the 48 h‐efficacy of continuous infusion via a catheter is reduced by a high displacement rate. We hypothesised that one‐time repetition of the single injection peripheral nerve blocks would provide effective analgesia with a low opioid consumption the first 48 postoperative hours.MethodsEleven subjects preoperatively received a popliteal sciatic and a saphenous single injection nerve block with a protracted local anaesthetic mixture. Surgery was performed under general anaesthesia. The one‐time repetition of the single injection nerve block was carried out approximately 24 h after the primary nerve block. The main outcomes were pain and cumulative opioid consumption during the first 48 postoperative hours.ResultsNine of the 11 (82%) patients had effective analgesia without opioids during the first 48 postoperative hours. Two patients each required a single dose of 7.5 mg of oral morphine equivalents after 43 h.ConclusionOne‐time repetition of single injection saphenous and sciatic nerve blocks consistently provided effective analgesia practically without opioids for 48 h after major elective ankle and hindfoot surgery.

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“…This work was part of a multi-phase evaluation of current evidence and current practice patterns for pain management after elective foot and ankle surgery. Our initial scoping review found sparse evidence for pain management, with few randomized trials, all of which investigated short-term pain outcomes following a perioperative nerve block [ 28 ]. In addition, after this evaluation of local prescribing practices, we undertook an international Delphi Consensus process to develop consensus-based guidelines for pre-, peri- and post-operative pain management following elective foot and ankle surgery [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Opioid prescribing practices prior to elective foot and ankle surgery: a population-based evaluation using health administrative data from a tertiary hospital in Canada

et al. 2022

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Background Complex elective foot and ankle surgery is known to be painful so most patients are prescribed opioids at the time of surgery; however, the number of patients prescribed opioids while waiting for surgery in Canada is unknown. Our primary objective was to describe the pre and postoperative prescribing practices for patients in Alberta, Canada undergoing complex elective foot and ankle surgery. Secondarily, we evaluated postoperative opioid usage and hospital outcomes. Methods In this population-based retrospective analysis, we identified all adult patients who underwent unilateral elective orthopedic foot and ankle surgery at a single tertiary hospital between May 1, 2015 and May 31, 2017. Patient and surgical data were extracted from a retrospective chart review and merged with prospectively collected, individual level drug dispensing administrative data to analyze opioid dispensing patterns, including dose, duration, and prescriber for six months before and after foot and ankle surgery. Results Of the 100 patients, 45 had at least one opioid prescription dispensed within six months before surgery, and of these, 19 were long-term opioid users (> 90 days of continuous use). Most opioid users obtained opioid prescriptions from family physicians both before (78%) and after (65%) surgery. No preoperative non-users transitioned to long-term opioid use postoperatively, but 68.4% of the preoperative long-term opioid users remained long-term opioid users postoperatively. During the index hospitalization, preoperative long-term opioid users consumed higher doses of opioids (99.7 ± 120.5 mg/day) compared to opioid naive patients (28.5 ± 36.1 mg/day) (p < 0.001). Long-term opioid users stayed one day longer in hospital than opioid-naive patients (3.9 ± 2.8 days vs 2.7 ± 1.1 days; p = 0.01). Conclusions A significant number of patients were dispensed opioids before and after foot and ankle surgery with the majority of prescriptions coming from primary care practitioners. Patients who were prescribed long-term opioids preoperatively were more likely to continue to use opioids at follow-up and required larger in-hospital opioid dosages and stayed longer in hospital. Further research and education for both patients and providers are needed to reduce the community-based prescribing of opioid medication pre-operatively and provide alternative pain management strategies prior to surgery to improve postoperative outcomes and reduce long-term postoperative opioid use.

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Perioperative pain management and chronic postsurgical pain after elective foot and ankle surgery: a scoping review

Cited by 7 publications

References 38 publications

Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture: a randomized clinical trial

Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture: a randomized clinical trial

Pain relief after major ankle and hindfoot surgery with repetitive peripheral nerve blocks: A feasibility study

Opioid prescribing practices prior to elective foot and ankle surgery: a population-based evaluation using health administrative data from a tertiary hospital in Canada

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