Reduced narcotic consumption seen with percutaneous foot and ankle surgery
CHICAGO — At the American Orthopaedic Foot and Ankle Society Annual Meeting, a presenter said there was significant decrease and cessation in narcotic consumption seen after percutaneous foot and ankle surgery with a multimodal program of analgesia compared with published reports of consumption after open procedures.
“This study gives us a glimpse that percutaneous foot and ankle surgery appears to improve pain control and decrease time to return to work,” Javier Z. Guzman, MD, said during his presentation. “What’s important is that all patients have a multimodal, well thought out comprehensive program of analgesia along with percutaneous surgery. This would help decrease the number of opioids.”
Guzman and colleagues prospectively identified 50 consecutive patients who underwent outpatient percutaneous foot and ankle surgery (bony procedures with or without soft tissue procedures). Thirty-six patients underwent forefoot surgeries, two patients underwent midfoot surgeries, eight patients underwent hindfoot surgeries and three patients underwent a combination of foot surgeries. Investigators noted all surgeries were conducted under general anesthesia and popliteal nerve blocks. Postoperatively, patients were prescribed 30 tablets of 5 mg oxycodone, 50 tablets of 500 mg acetaminophen and nine tablets of 600 mg ibuprofen for pain control. Using a log sheet, patients recorded the number of pain medications taken during first 14 postoperative days. At the 2-week postoperative visit, researchers collected the log sheet and leftover pills. Investigators counted the leftover pills to confirm the amount of medication used. At a subsequent follow-up appointment, the time to return to work was recorded.
Results showed that, on average, 3.3 oxycodone tablets were taken during the first 14 days after surgery. No patients took any narcotic medication by the fourteenth day. Investigators noted the average return to work was 18.9 days postoperatively.
On average, patients who underwent forefoot surgery took 2.2 tablets of oxycodone and returned to work at 10.4 days. Patients who underwent midfoot surgery took an average of 3.5 oxycodone tablets and returned to work at 33 days. Patients who underwent hindfoot surgery took an average of 5.3 oxycodone tablets and returned to work at 38.9 days. On average, patients who underwent combined foot surgery took 11 tablets of oxycodone and returned to work at 54.3 days. – by Monica Jaramillo
Guzman JZ, et al. Introduction opioid consumption and time to return to work after percutaneous foot and ankle surgery. Presented at: American Orthopaedic Foot and Ankle Society Annual Meeting; Sept. 12-15, 2019; Chicago.
Disclosure: Guzman reports no relevant financial disclosures.