Foot & Ankle Reconstruction Journal Scan

Multimodal Analgesia Therapy Reduces Length of Hospitalization in Patients Undergoing Fusions of the Ankle and Hindfoot.

Foot Ankle Int. 2013 Jul 8;

Authors: Michelson JD, Addante RA, Charlson MD

Abstract
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.