546850
research-article2014
FAIXXX10.1177/1071100714546850Foot & Ankle InternationalPinzur
FootForum Foot & Ankle International® 2014, Vol. 35(11) 1237 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100714546850 fai.sagepub.com
Opioid Use and Abuse Michael S. Pinzur, MD1
All of us desire to make the perioperative surgical experience as positive as possible for patients undergoing surgery. It is clear that minimizing pain is a major component necessary to achieve that goal. Foot and ankle surgeons have led the way in this endeavor by using regional anesthesia, longacting nerve blocks, and other methods to minimize the negative experience of surgery for our patients. This effort to raise awareness of attacking patient perceived pain has led to greatly liberalized opioid prescribing patterns in North America. Those of us in tertiary medical centers have observed the development of an epidemic of opioid addiction. This was the subject of a recent FootForum.1 I received this very interesting letter from a well-respected colleague, Alistair Younger, MBChB, MScChM, who is well known to readers of Foot & Ankle International. I read your comment on drug use with interest. I always suspected that the opioid recommendations were highly biased. I am also uncomfortable with prescribing at the levels requested or required when patients have been put on opioids to achieve postoperative pain relief. Oxycodone is worth 1 dollar per milligram near our hospital and is the favorite drug of our gangs. Our hip and knee colleagues tell the residents to prescribe 100 pills of 10 mg of oxycodone—worth 1000 dollars on the street.
What are other surgeons’ methods of dealing with this problem? My preop requirements now for elective surgery are: 1. 2. 3. 4. 5.
No smoking or nicotine of any sort HBA1c under 8 for patients with diabetes (ideally under 7) No narcotics BMI under 35 No cocaine or cocaine like drugs
This well-respected colleague raises some very interesting points. Do we withhold elective reconstructive surgery from patients using long-acting opioids, smokers, or diabetics with less than optimal diabetic management? How about morbidly obese patients? What is our threshold for each of these characteristics that are clearly associated with inferior results? We would like to use the FootForum as a pulpit to discuss these important issues. If you have opinions, comments, or suggestions, contact the FootForum at [email protected]. Reference 1. Pinzur MS. FootForum: the fifth vital sign. Foot Ankle Int. 2013;34:1605. PMID:24178799.
I have adopted the following policy: 1. All patients have to be off long-acting narcotics before surgery 2. They will only be prescribed medication as if they had never been prescribed 3. I will prescribe 30 pills of 10 mg oxycodone (no oxyneo or oxycontin) for the acute period 4. I will only do a repeat with direct discussion with the patient 5. I will convert down to tramadol with acetaminophen (not codeine with acetaminophen) as soon as possible
1
Loyola University Health System, Maywood, IL, USA
Corresponding Author: Michael S. Pinzur, MD, Loyola University Health System, Orthopaedic Surgery, 2160 S First Ave, Maywood, IL 60153, USA. Email: [email protected]
Downloaded from fai.sagepub.com at Freie Universitaet Berlin on May 9, 2015
research-article2014
FAIXXX10.1177/1071100714546850Foot & Ankle InternationalPinzur
FootForum Foot & Ankle International® 2014, Vol. 35(11) 1237 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100714546850 fai.sagepub.com
Opioid Use and Abuse Michael S. Pinzur, MD1
All of us desire to make the perioperative surgical experience as positive as possible for patients undergoing surgery. It is clear that minimizing pain is a major component necessary to achieve that goal. Foot and ankle surgeons have led the way in this endeavor by using regional anesthesia, longacting nerve blocks, and other methods to minimize the negative experience of surgery for our patients. This effort to raise awareness of attacking patient perceived pain has led to greatly liberalized opioid prescribing patterns in North America. Those of us in tertiary medical centers have observed the development of an epidemic of opioid addiction. This was the subject of a recent FootForum.1 I received this very interesting letter from a well-respected colleague, Alistair Younger, MBChB, MScChM, who is well known to readers of Foot & Ankle International. I read your comment on drug use with interest. I always suspected that the opioid recommendations were highly biased. I am also uncomfortable with prescribing at the levels requested or required when patients have been put on opioids to achieve postoperative pain relief. Oxycodone is worth 1 dollar per milligram near our hospital and is the favorite drug of our gangs. Our hip and knee colleagues tell the residents to prescribe 100 pills of 10 mg of oxycodone—worth 1000 dollars on the street.
What are other surgeons’ methods of dealing with this problem? My preop requirements now for elective surgery are: 1. 2. 3. 4. 5.
No smoking or nicotine of any sort HBA1c under 8 for patients with diabetes (ideally under 7) No narcotics BMI under 35 No cocaine or cocaine like drugs
This well-respected colleague raises some very interesting points. Do we withhold elective reconstructive surgery from patients using long-acting opioids, smokers, or diabetics with less than optimal diabetic management? How about morbidly obese patients? What is our threshold for each of these characteristics that are clearly associated with inferior results? We would like to use the FootForum as a pulpit to discuss these important issues. If you have opinions, comments, or suggestions, contact the FootForum at [email protected]. Reference 1. Pinzur MS. FootForum: the fifth vital sign. Foot Ankle Int. 2013;34:1605. PMID:24178799.
I have adopted the following policy: 1. All patients have to be off long-acting narcotics before surgery 2. They will only be prescribed medication as if they had never been prescribed 3. I will prescribe 30 pills of 10 mg oxycodone (no oxyneo or oxycontin) for the acute period 4. I will only do a repeat with direct discussion with the patient 5. I will convert down to tramadol with acetaminophen (not codeine with acetaminophen) as soon as possible
1
Loyola University Health System, Maywood, IL, USA
Corresponding Author: Michael S. Pinzur, MD, Loyola University Health System, Orthopaedic Surgery, 2160 S First Ave, Maywood, IL 60153, USA. Email: [email protected]
Downloaded from fai.sagepub.com at Freie Universitaet Berlin on May 9, 2015
