The Effects of Anesthetic Technique on Postoperative Opioid Consumption in Ankle Fracture Surgery

Christensen, K. P.; Møller, Ann Merete; Nielsen, Jens Perch; Klausen, Tobias Wirenfeldt; Sort, Rune

doi:10.1097/ajp.0000000000000335

Cited by 28 publications

(23 citation statements)

References 17 publications

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“…Kir et al 9 demonstrated in a randomized controlled trial that regional anesthesia in combination with general anesthesia for hallux valgus surgery was associated with decreased visual analog scale (VAS) pain scores and higher American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores at 3, 6, and 12 months postoperatively, when compared to general anesthesia alone. Christensen et al 5 found that after operative fixation of ankle fractures, patients who received only general anesthesia required significantly more narcotic pain medication over the 24-hour perioperative period compared with patients who received a peripheral nerve block, spinal anesthesia, or both. In our study, we did not see a significant effect of the type of anesthesia on opioid prescription practice or patient response to pain control.…”

Section: Discussionmentioning

confidence: 99%

Effect of the Strengthening Opioid Misuse Prevention (STOP) Act on Opioid Prescription Practices After Ankle Fracture Fixation

Hussaini

Wang

Luo

et al. 2019

Foot & Ankle Orthopaedics

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Background: In North Carolina, the Strengthen Opioid Misuse Prevention Act of 2017 (STOP Act) went into effect on January 1, 2018, intending to increase oversight over opioid prescriptions. This study compares postoperative narcotic prescription practices following operative fixation of ankle fractures before and after the STOP Act. Methods: This study was a retrospective review of patients 18 years and older who underwent operative fixation of ankle fractures between January 1 and June 30, 2017 (before STOP Act), and between January 1 and June 30, 2018 (after STOP Act). Variables of interest included demographics, amount of opioids prescribed postoperatively, number of prescription refills, and number of pain-related calls or visits to the emergency department (ED) or clinic after surgery. This study assessed 71 patients in the Pre group and 47 patients in the Post group. Results: There was a statistically significant decrease in the average number of postoperative narcotic pills prescribed after the STOP Act (52.7 vs 76.2, P < .001). There was also a statistically significant decrease in the average number of prescription refills (0.6 vs 1.0, P = .037). There were no significant changes in pain-related clinic calls (35.2% Pre vs 34.0% Post, P = .896), pain-related clinic visits ahead of schedule (4.2% Pre vs 6.4% Post, P = .681), or pain-related ED visits (2.8% Pre vs 10.6% Post, P = .113). Conclusion: In the postoperative period after operative fixation of ankle fractures, the volume of narcotic prescriptions decreased after the new legislation, without an associated strain on medical resources. Level of Evidence: Level III, therapeutic, comparative study.

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Section: Discussionmentioning

confidence: 99%

Effect of the Strengthening Opioid Misuse Prevention (STOP) Act on Opioid Prescription Practices After Ankle Fracture Fixation

Hussaini

Wang

Luo

et al. 2019

Foot & Ankle Orthopaedics

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“…30 Recent studies show regular overprescription of narcotic pain medication following upper extremity surgery and isolated lower extremity procedures such as open reduction and internal fixation (ORIF) of ankle fractures and total ankle arthroplasty. 5,11,15,[16][17][18][19]21,27,29,34,40 However, there remains limited comprehensive literature regarding utilization rates after outpatient lower extremity procedures. 2,22,26,32,33 The largest outpatient foot and ankle study to date enrolled fewer than 180 patients.…”

Section: Introductionmentioning

confidence: 99%

Prospective Evaluation of Utilization Patterns and Prescribing Guidelines of Opioid Consumption Following Orthopedic Foot and Ankle Surgery

et al. 2018

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“…Peripheral nerve blocks are gaining popularity for orthopaedic limb surgery , but little is known about how patients experience peripheral nerve blocks as both anaesthesia and pain control. Peripheral nerve blocks are considered safe; they reduce postoperative opioid consumption and their long‐lasting effect improves patient satisfaction in elective surgery . Peripheral nerve blocks are widely used even for acute trauma surgery, where pain experiences are different and documentation of peripheral nerve block benefits remains scarce.…”

Section: Introductionmentioning

confidence: 99%

Peripheral nerve block in ankle fracture surgery: a qualitative study of patients’ experiences

et al. 2017

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Summary Peripheral nerve blocks are popular as a mode of anaesthesia for limb surgery and their beneficial effects are well documented in elective surgery. However, concerns have been raised about potential rebound pain outweighing the benefits in acute ankle fracture surgery. Furthermore, pain scores and morphine consumption do not provide a full picture, as pain is subjective. To evaluate the clinical usefulness of peripheral nerve blocks, we explored patients’ expectations and experiences by means of semi‐structured interviews analysed with systematic text condensation. We obtained ethical approval and informed consent and sampled purposively among adult patients scheduled for ankle surgery with nerve blocks as the primary mode of anaesthesia. Patients were interviewed within 48 h postoperatively. Data saturation was reached after 13 interviews. We found that, despite pre‐emptive ibuprofen and paracetamol, some patients did experience excruciating rebound pain for up to 2 h, although most had little or no pain. The patients had doubts about what to do when the block wore off, which led to a risk of unnecessary pain levels or morphine overuse. Patients had difficulty understanding the effect and course of the nerve blocks. They had misunderstandings regarding the blocks’ effect on sensation, resulting in fear of feeling pain during surgery and of permanent nerve damage after surgery. However, patients valued the mental alertness, ability to ambulate and efficient pain relief provided by the blocks. We recommend that patients be given thorough and repeated information as we feel this is crucial in preventing undesirable responses from patients, and is likely to increase the overall clinical usefulness of nerve blocks in acute limb surgery.

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The Effects of Anesthetic Technique on Postoperative Opioid Consumption in Ankle Fracture Surgery

Abstract: Regional anesthesia modalities reduce postoperative opioid consumption in ankle fracture surgery in comparison with GA. A benefit of PNBs is possibly due to an improved pain profile. Our study is retrospective and cannot predict the exact magnitude of this benefit.

Cited by 28 publications

References 17 publications

Effect of the Strengthening Opioid Misuse Prevention (STOP) Act on Opioid Prescription Practices After Ankle Fracture Fixation

Effect of the Strengthening Opioid Misuse Prevention (STOP) Act on Opioid Prescription Practices After Ankle Fracture Fixation

Prospective Evaluation of Utilization Patterns and Prescribing Guidelines of Opioid Consumption Following Orthopedic Foot and Ankle Surgery

Peripheral nerve block in ankle fracture surgery: a qualitative study of patients’ experiences

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