Pain Management After Outpatient Foot and Ankle Surgery.
BACKGROUND
The number of opioids prescribed and used has increased precipitously over the past 2 decades for a number of reasons and has led to increases in long-term dependency, opioid-related deaths, and diversion. Most studies examining the role of prescribing habits have investigated nonoperative providers, although there is some literature describing perioperative opioid prescription and use. There are no studies looking at the number of pills consumed after outpatient foot and ankle surgeries, nor are there guidelines for how many pills providers should prescribe. The purpose of this study was to quantify the number of narcotic pills taken by opioid-naïve patients undergoing outpatient foot and ankle surgeries with regional anesthesia.


METHODS
Eighty-four patients underwent outpatient foot and ankle surgeries under spinal blockade and long-acting popliteal blocks. Patients were given 40 or 60 narcotic pills, a 3-day supply of ibuprofen, deep vein thrombosis prophylaxis, and antiemetics. Patients received surveys at postoperative day (POD) 3, 7, 14, and 56 documenting if they were still taking narcotics, the quantity of pills consumed, whether refills were obtained, their pain level, and their reason for stopping opioids.


RESULTS
Patients consumed a mean of 22.5 pills, with a 95% confidence interval from 18 to 27 pills. Numerical Rating Scale pain scores started at 4 on POD 3 and decreased to 1.8 by POD 56. The percentage of patients still taking narcotics decreased from 55% on POD 3 to 2.8% by POD 56. Five new prescriptions were given during the study, with 3 being due to side effects from the original medication.


CONCLUSIONS
Patients receiving regional anesthesia for outpatient foot and ankle surgeries reported progressively lower pain scores with low narcotic use up to 56 days postoperatively. We suggest that providers consider prescribing 30 pills as the benchmark for this patient population.


LEVEL OF EVIDENCE
Level II, prospective comparative study.
['Gupta|Akash|A|', 'Kumar|Kanupriya|K|', 'Roberts|Matthew M|MM|', 'Sanders|Austin E|AE|', 'Jones|Mackenzie T|MT|', 'Levine|David S|DS|', "O'Malley|Martin J|MJ|", 'Drakos|Mark C|MC|', 'Elliott|Andrew J|AJ|', 'Deland|Jonathan T|JT|', 'Ellis|Scott J|SJ|']
D000701:Analgesics, Opioid D000842:Ankle D005528:Foot D006801:Humans D009294:Narcotics D010045:Outpatients D010149:Pain, Postoperative D011184:Postoperative Period D011446:Prospective Studies D011795:Surveys and Questionnaires
opioid narcotic regional anesthesia spinal outpatient surgery popliteal blockade