Prospective Evaluation of Opioid Consumption in Multimodal Analgesia Following Isolated Hallux Valgus Correction or First MTP Joint Arthrodesis

Abstract

Category: Other; Bunion; Midfoot/Forefoot Introduction/Purpose: There is no standard guideline for prescription opioids for postoperative pain management following outpatient foot and ankle surgery. Multiple previous studies demonstrated that opioids were overprescribed. The purpose of this study was to prospectively investigate opioid consumption using multimodal analgesia regimen after two of the most common forefoot surgeries: isolated hallux valgus correction or 1st metatarsophalangeal (MTP) joint arthrodesis. Methods: We prospectively investigated opioid prescription and consumption of total 21 patients who underwent isolated hallux valgus correction with distal soft tissue procedure and proximal first metatarsal crescentic osteotomy or 1st MTP joint arthrodesis. Postoperative pain was managed using multimodal analgesia including oxycodone, ibuprofen, acetaminophen, and regional ankle block. Patients were instructed to take 5mg of oxycodone every 4 hours as needed, and 600 mg of ibuprofen as well as 1,000 mg of acetaminophen every 8 hours regularly. The number of pills patients consumed for oxycodone was recorded at postoperative follow-up at 1-week, 2-week, 4-week, 8-week, and 12-week. Subgroup analysis was performed to evaluate opioid consumption according to the prescription type: Only oxycodone was prescribed in group A while oxycodone as well as prescription strength ibuprofen and acetaminophen were prescribed in group B. Another subgroup analysis in opioid consumption was performed based on the quantity of opioid prescription and procedure type. Results: The overall mean opioid consumption in 12 weeks of the postoperative period was 16.2 pills per patient with an average of 37.3 pills prescribed. Lower opioid consumption was noted in group B when prescription ibuprofen and acetaminophen were prescribed compared to group A when patients took over-the-counter (OTC) ibuprofen and acetaminophen: 9.0 pills vs 24.1 pills, respectively (P = 0.036). There was a trend showing higher opioid consumption in patients prescribed greater than 30 pills of oxycodone compared to less than or equal to 30 pills: 22.0 pills vs 9.8 pills, respectively (P = 0.099). No significant difference was found in opioid consumption according to the procedure type: 15.8 pills in hallux valgus correction vs 16.5 pills in 1st MTP joint arthrodesis (P = 0.750). Conclusion: This study showed that on the average, patients took 16.2 pills out of 37.3 pills of the prescribed oxycodone after isolated hallux valgus correction or 1st MTP joint arthrodesis using our multimodal analgesia regimen. Patients who were prescribed prescription strength ibuprofen and acetaminophen consumed opioid significantly less than those who took the OTC strength. No significant difference was noted in opioid consumption between isolated hallux valgus correction and 1st MTP joint arthrodesis.