One Surgeon’s Experience with a Low-Opioid Postoperative Pain Protocol for Foot and Ankle Surgery

BACKGROUND: The opioid epidemic has become incredibly problematic in the United States, leading to more than 80,000 deaths in 2021 alone. There are no studies in the foot and ankle surgery literature attempting to develop a multimodal low-opioid postoperative pain protocol. We present a retrospective evaluation of 20 patients who were prescribed a novel postoperative low-opioid protocol. METHODS: Patients who underwent foot and ankle surgery were briefly counseled on expectations and were told to follow a protocol consisting of 400 mg of ibuprofen and 1,000 mg of acetaminophen every 6 hours (either together or alternating) with 15 mg of morphine sulfate immediate release for breakthrough pain. RESULTS: Postoperative subjective pain scores using a visual analog scale from 0 to 10 and the number and type of oral dosing unit (tablets consumed) were taken from the medical record data. The average number of morphine milliequivalents taken among all of the patients during the postoperative period was 27.75. The mean total number of morphine sulfate immediate-release 15-mg tablets taken was 1.85. Average visual analog scale scores on days 3, 5, and 7 were 5.40, 4.50, and 2.25, respectively. CONCLUSIONS: This study demonstrates that there may be rampant overprescription of opioids after foot and ankle surgery and that there is a protocol with significantly less opioid burden that is not inferior to current regimens.