Document Detail


Multimodal analgesia therapy reduces length of hospitalization in patients undergoing fusions of the ankle and hindfoot.
MedLine Citation:
PMID:  23836812     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Multimodal postoperative analgesia employs multiple medications given perioperatively to block the generation and perception of pain at different points in the nociceptive pathway. This retrospective study examines its effect on the length of stay for patients undergoing hindfoot and ankle fusions.
METHODS: All patients operated upon by the senior authors between 2007 and 2011, inclusive, underwent ankle fusion, subtalar fusion, pantalar arthrodesis, triple arthrodesis, or combined ankle/subtalar fusions. The perioperative pain management was either the "traditional" method (patient-controlled-analgesia-delivered parenteral narcotics beginning immediately postoperatively) or the multimodal pain protocol (pre- and postoperative oral administration of opioids, celecoxib, pregabalin, acetaminophen, and prednisone). The choice of pain protocol was up to the surgeons, without any exclusion criteria. Physical therapy protocols were not changed during the study. The study included 220 patients; 175 received the multimodal protocol and 45 received traditional management. Multimodal protocol patients were younger (53.9 vs 59.7 years; P < .003), but there were no other differences between the groups with respect to gender, obesity, body mass index, tobacco use, alcohol use, or comorbidities. Complex cases (revision surgeries, Charcot joint surgeries, multiple concurrent procedures, etc) were equally represented in both groups.
RESULTS: Multimodal protocol patients had lower lengths of stay (2.5 days; 95% confidence interval [CI], 1.4-3.7) than traditional pain management patients (4.2 days; 95% CI, 2.7-5.7; P < .001). This was also true for both complicated and uncomplicated surgeries when considered separately.
CONCLUSION: This study provides the first evidence that multimodal therapy reduces the length of stay for patients undergoing major hindfoot or ankle fusion surgery, regardless of surgical complexity.
LEVEL OF EVIDENCE: Level III, comparative series.
Authors:
James D Michelson; Raymond A Addante; Mark D Charlson
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2013-07-08
Journal Detail:
Title:  Foot & ankle international     Volume:  34     ISSN:  1944-7876     ISO Abbreviation:  Foot Ankle Int     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-01     Completed Date:  2014-07-22     Revised Date:  2014-08-27    
Medline Journal Info:
Nlm Unique ID:  9433869     Medline TA:  Foot Ankle Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1526-34     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Acetaminophen / therapeutic use
Analgesia, Patient-Controlled
Analgesics / therapeutic use
Analgesics, Opioid / therapeutic use
Anesthesia, General
Anesthesia, Spinal
Ankle Joint / surgery*
Anti-Inflammatory Agents / therapeutic use
Arthrodesis*
Cyclooxygenase 2 Inhibitors / therapeutic use
Drug Therapy, Combination
Female
Humans
Hydromorphone / therapeutic use
Length of Stay / statistics & numerical data*
Male
Middle Aged
Morphine / therapeutic use
Oxycodone / therapeutic use
Pain Management / methods*
Pain, Postoperative / prevention & control*
Postoperative Care
Prednisone / therapeutic use
Preoperative Care
Pyrazoles / therapeutic use
Retrospective Studies
Subtalar Joint / surgery
Sulfonamides / therapeutic use
gamma-Aminobutyric Acid / analogs & derivatives,  therapeutic use
Chemical
Reg. No./Substance:
0/Analgesics; 0/Analgesics, Opioid; 0/Anti-Inflammatory Agents; 0/Cyclooxygenase 2 Inhibitors; 0/Pyrazoles; 0/Sulfonamides; 169590-42-5/celecoxib; 362O9ITL9D/Acetaminophen; 55JG375S6M/pregabalin; 56-12-2/gamma-Aminobutyric Acid; 76I7G6D29C/Morphine; CD35PMG570/Oxycodone; Q812464R06/Hydromorphone; VB0R961HZT/Prednisone
Comments/Corrections
Comment In:
Foot Ankle Int. 2013 Dec;34(12):1749   [PMID:  24319033 ]
Foot Ankle Int. 2013 Dec;34(12):1747-8   [PMID:  24319032 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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