TY - JOUR
T1 - Multimodal analgesia therapy reduces length of hospitalization in patients undergoing fusions of the ankle and hindfoot
AU - Michelson, James D.
AU - Addante, Raymond A.
AU - Charlson, Mark D.
N1 - Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2013/11
Y1 - 2013/11
N2 - 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.
AB - 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.
KW - fusion
KW - outcome study
KW - pain management
KW - surgery
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U2 - 10.1177/1071100713496224
DO - 10.1177/1071100713496224
M3 - Article
C2 - 23836812
AN - SCOPUS:84887138186
SN - 1071-1007
VL - 34
SP - 1526
EP - 1534
JO - Foot and Ankle International
JF - Foot and Ankle International
IS - 11
ER -