SLR - July 2023 - Danielle Nack, DPM
Title: A Prospective Observational Study of Persistent Opioid Use After Complex Foot and Ankle SurgeryReference: Verrier M, Niu S, Kroetch K, Buro K, Douglas C, Green J, Pedersen ME, Dillane D. A prospective observational study of persistent opioid use after complex foot and ankle surgery. Can J Anaesth. 2022 Aug;69(8):945-952. English. doi: 10.1007/s12630-021-02104-0. Epub 2021 Sep 24. PMID: 34561837.
Level of Evidence: Level III
Scientific Literature Review
Reviewed By: Danielle Nack, DPM
Residency Program: HealthPartners Institute/Regions Hospital in Saint Paul, Minnesota
Podiatric Relevance: Opioids are a common component of multimodal postsurgical pain management that are prescribed on a daily basis by foot and ankle surgeons all around the United States. With the recent increase in opioid addiction and opioid crisis, it is crucial that surgeons prescribing these type of narcotics are well aware of the side effects and high addiction rates these pills can have on our patients. This study aims to try and analyze the incidence of persistent postsurgical opioid use (PPOU) after foot and ankle surgery in opioid naïve, occasional and regular opioid users at baseline and at six weeks, three months, and six months postoperatively. The goal of this study is to hopefully bring more awareness and knowledge to all prescribing surgeons as opioid analgesia is the standard of care for acute postoperative pain in North America.
Methods: A prospective observational study in patients undergoing complex foot and ankle surgery deemed painful enough to require a peripheral nerve block were studied over an 18-month period. A total of 82 patients were included in the study. The relationship between regularity of opioid use recorded at the postoperative anesthesia visit, and at six weeks, three months, and six months after surgery. Logistic regression models were utilized to predict the risk of opioid use at these intervals. The Brief Pain Inventory (BPI) was used to record pain intensity and interference.
Results: Authors found that 6% of patients who were not using opioids preoperatively at baseline were using opioids daily at three and six months after surgery. 50% of patients who were regular opioid users preoperatively continued to use opiods daily six months after surgery. All associations between the brief pain inventory interference parameters and opioid use were estimated to be positive.
Conclusion: Overall this prospective observation study found the probability of using opioid analgesia six months after complex foot and ankle surgery was significantly higher in patients who used opioids preoperatively. Regular preoperative opioid use was associated with a greater risk of persistent postsurgical opioid use compared with occasional or chronic opioid use prior to surgery. This was a very eye opening study with some alarming data about opioid use for postoperative pain management. I believe it is crucial as surgeons to really gain a thorough history with all patients and to discuss different options for pain management that could be just as effective as narcotics, but with a safer risk profile. This knowledge is also important and useful so surgeons can educate their patients about the risks associated with these type of postoperative pain medications.