Utilization of Over the Counter Analgesics Post-Operatively in Foot and Ankle Surgery

CATEGORY: Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/Biologics, Bunion, Hindfoot, Lesser Toes, Midfoot/Forefoot, Sports, Trauma INTRODUCTION/PURPOSE: Managing post-operative pain in patients has become a growing concern given the increasing focus on controlling opioid use. Over the counter (OTC) analgesics such as tylenol and ibuprofen have been shown to be useful adjuncts to post-operative pain regimens and may decrease opioid use. However utilization of these adjuncts may be limited by patient education especially if they are not formally prescribed by the physcian. In this work we aim to identify how often post-operative patients utilize OTC analgesics to supplement their pain control and what are the barriers to usage. METHODS: All bony foot and ankle procedures performed by a single foot and ankle surgeon were reviewed between the dates of 7/1/2017 - 6/30/2018. Inclusion criteria were age over 18 and not incarcerated. Bony procedures included any osteotomy, fracture fixation, or arthrodesis. This subset of patients were then called and surveyed about their post-operative pain. 114 patients met inclusion criteria. RESULTS: 42 patients responded to the survey. 27 (64%) of patients did not supplement their pain control with OTC analgesics. The most common reason why (13/27 patients) OTC meds were not used was because pain control on narcotics alone was sufficient. Other reasons included dislike of polypharmacy, not believing they would be efficacious, and not knowing that it is was safe to take them. Total narcotic use between the two groups was higher in the OTC group however (760 mg morphine equivalent in the no OTC group and 1073 mg morphine equivalent in the OTC group, p = 0.25). CONCLUSION: This study highlights the misconception of patients in regards to optimal pain control. The higher absolute narcotic usage in the OTC group may reflect that patients who feel the need to supplement their pain regimen have lower pain tolerance to begin with.