Optimal and Safe Pain Management Approach in Ankle and Hindfoot Fractures: Improving Practitioner Decision

BackgroundOver or sub-optimal analgesic treatment leads to undesired consequences and patient dissatisfaction. The study aims to assess the sub-optimal or optimal pain relief and safety of routinely prescribed oral analgesic(s) at discharge and 1-week post-discharge in ankle and foot fracture surgeries. MethodsThe ongoing prospective cohort study data on 54 ankle and hindfoot trauma fracture adult patients enrolled between June 2022 to July 2023 was analyzed. Post-surgery oral analgesics prescribed at hospital discharge and 1-week follow-up were stratified for assessing adverse events and pain (Visual Analogue Scale) at 1- and 2 weeks post-discharge. The relationship of age, gender, and comorbidity was analyzed by multiple logistic regression for adverse events and multiple linear regression for pain score. ResultsMedian pain scores at 1- and 2-week follow-ups were 3.2 (IQR=3.0) and 2 (IQR=2.0) respectively. Combinations of tramadol, acetaminophen with naproxen or diclofenac or orphenadrine; and naproxen, pregabalin, with acetaminophen seemed toxic with sub-optimal pain control. Similar results were for celecoxib combined with pregabalin and etoricoxib combined with diclofenac or tramadol. Acetaminophen alone was safe but occasionally showed intolerance. Etoricoxib or diclofenac alone or with acetaminophen was safe and showed better pain control in this cohort. A regression model was non-significant for a relationship between covariates and pain scores or adverse events. ConclusionCurrent data suggests that certain oral analgesics or their combinations are harmful with sub-optimal pain control while some are safe and effective. Choosing suitable analgesics or their combinations in specific fractures might reduce patient harm with optimal pain management.