Prospective Evaluation of Opioid Consumption in Multimodal Analgesia Following Hallux Valgus Correction or First Metatarsophalangeal Joint Arthrodesis in Isolation

Background: There is no standard guideline for prescription opioids for postoperative pain management following outpatient foot and ankle surgery. The purpose of this study was to investigate opioid consumption using a multimodal analgesia regimen after 2 common forefoot surgeries. Methods: We prospectively investigated opioid prescription and consumption of 21 patients who underwent isolated hallux valgus correction with distal soft tissue procedure and proximal first metatarsal crescentic osteotomy or first metatarsophalangeal (MTP) joint arthrodesis. Postoperative pain was managed using multimodal analgesia including oxycodone, ibuprofen, acetaminophen, and regional ankle block. The number of oxycodone pills consumed was recorded at 1-week, 2-week, 4-week, 8-week, and 12-week follow-up. Within the same total cohort (N = 21), 3 subgroup analyses were performed. The first was according to the prescription type: only oxycodone (n = 10) was prescribed in group A, while oxycodone as well as prescription-strength ibuprofen and acetaminophen were prescribed in group B (n = 11). The second subgroup analysis was performed based on the quantity of opioid prescription: patients were stratified into 2 subgroups: ≤30 pills in group C (n = 10) and >30 pills in group D (n = 11). The third subgroup analysis was based on the procedure type: hallux valgus correction group (n = 10) versus first MTP joint arthrodesis group (n = 11). Results: Overall mean opioid consumption at 12 weeks postoperatively was 16.2 pills with 37.3 pills prescribed (43.4%). Lower opioid consumption was noted in group B (9.0 pills) than group A (24.1 pills) ( P = 0.036). Conclusions: Our cohort consumed only 43.4% of 5 mg oxycodone prescribed (16.2 out of 37.3 pills) using our multimodal analgesia protocol after 2 common forefoot surgeries. A lower amount of opioid consumption was noted in patients given alternative pain medication prescriptions. We recommend a multimodal analgesia protocol to manage postoperative pain and decrease the amount of opioids prescribed and taken. Level of Evidence: Level II, prospective observational cohort study.