Comparison of an Opioid-Free Multimodal Pain Regimen to an Opioid-Containing Regimen in Elective,Outpatient,Bunion,and Forefoot Surgery

Abstract

Background

Multimodal, opioid-free regimens for postoperative pain have been increasing in popularity due to concerns regarding the current opioid crisis. Despite their increased popularity, there is limited evidence regarding the effectiveness of these regimens for outpatient forefoot procedures. This study looks to compare a multimodal, opioid-free pain control regimen to a historical opioid regimen in patients undergoing elective, outpatient forefoot procedures.

Methods

Data were collected prospectively in patients undergoing elective outpatient forefoot procedures, including bunion, bunionette, and lesser toe corrections, who were using a multimodal pain regimen, consisting of Acetaminophen, Meloxicam, Ketorolac, Cyclobenzaprine, and Pregabalin, from December 2020 to June 2022 and retrospectively for patient’s undergoing similar procedures using an opioid-containing regimen, consisting of either oxycodone or hydrocodone, from October 2018 to February 2020 to at a single academic institution. Demographic information, VAS pain scores, satisfaction rating, and rescue opioid medication use were recorded. Continuous data were compared using the Wilcoxon Rank Sum test. A multivariable linear regression analysis was used to determine factors influencing a patient’s VAS pain scores at 2 weeks postoperatively when controlling for confounding variables. All P < .05 were considered significant.

Results

A total of 41 patients were included in the opioid-free multimodal regimen group and 59 in the opioid-containing group. There was no significant difference between the multimodal group and opioid group in VAS pain score at 2 weeks postoperatively (1.4 vs 1.0, P = .26). Patients in the multimodal group had an 88% satisfaction rating. 17% required rescue opioid medications. Multivariable analysis demonstrated utilization of the multimodal pain regimen did not significantly influence VAS scores at 2 weeks postoperatively when controlling for confounding variables (P = .06).

Conclusion

Our multimodal, opioid-free pain control regimen demonstrated similar effectiveness, with high satisfaction and low rescue opioid use, as an opioid-containing regimen in patients undergoing elective outpatient foot and ankle procedures. These findings demonstrate this multimodal pain regimen is effective at controlling postoperative pain in patients undergoing elective outpatient forefoot procedures.

Level of Evidence:

II