Prescribing Fewer Opioid Pills to Hallux Valgus Patients Undergoing Minimally Invasive Bunion Correction: A Prospective Comparative Study

CATEGORY: Bunion; Midfoot/Forefoot INTRODUCTION/PURPOSE: This study aims to compare opioid usage and patient satisfaction with postoperative pain management in similar hallux valgus (HV) patients who underwent minimally invasive distal chevron akin (MIS) correction with patients who underwent modified Lapidus and scarf corrections. We hypothesized that patients who underwent minimally invasive bunionectomy would consume fewer opioids and report similar satisfaction with pain management compared with modified lapidus and scarf patients. METHODS: This study is a single center prospective study of 33 patients diagnosed with hallux valgus undergoing MIS bunion correction who received a novel opioid prescribing protocol used by the senior author. Preoperatively, patients undergoing MIS corrections were counseled on the expectations of pain after surgery, received a take home pamphlet, and were prescribed opioids for moderate surgery (5-15 pills). These patients were then compared to a cohort of 25 hallux valgus patients status post Lapidus or scarf bunionectomy who were prescribed 40-60 opioid pills without preoperative coaching or handouts. Patients were excluded if they used opioids or muscle relaxants preoperatively or had a known history of a substance use disorder. Patients completed surveys postoperatively for eight weeks reporting pain level, number of opioid pills consumed, refill requests, and satisfaction with their pain management plan. RESULTS: There was a significant difference (p< 0.001) in mean pills consumed between MIS patients who averaged 2.5 opioid pills (5mg Oxycodone/pill) and modified Lapidus and scarf patients who averaged 25.2 opioid pills (5mg Oxycodone/pill) at all time points (Table 1). There was no significant difference between the ratio of pills taken to pills prescribed between both groups (p>0.05). Patients had comparable levels of pain at all time points (p>0.05). MIS patients did not request any refills, whereas Lapidus and scarf patients requested a total of 5 refills over the course of the study. CONCLUSION: HV patients who underwent MIS correction achieved equivalent analgesic effect when compared to similar HV patients who underwent Lapidus or scarf procedures. The Lapidus and scarf group received approximately four times the amount of opioids and consumed 11 times the amount of pills. This study demonstrates that HV patients undergoing MIS bunion correction require far fewer opioid pills to achieve the same level of postoperative pain control compared with Lapidus and scarf patients. This study also suggests that a novel postoperative prescribing protocol utilized by the senior surgeon may decrease the number of pills both prescribed and consumed by patients.