By: Dr. Jesseka Kaldenberg-Leppert, DPM
One of the primary concerns of patients following foot and ankle surgical intervention is pain control. Many patients have heard terrible stories of pain from other patients after their bunion surgery especially. At Foot & Ankle Center of Iowa, we place a high priority on pain management and have implemented a multimodal pain management regimen (utilization of a combination of therapies to attack pain in different ways) for postoperative patients that has had great success over the last decade. Adoption of this multimodal pain management regimen for foot and ankle surgery came from a desire to provide patients with improved pain control while limiting utilization of potentially addictive narcotics.
Foot & Ankle Center of Iowa pain management starts prior to your surgical intervention by administering a preoperative ankle block with local anesthesia. By blocking the nerves prior to the start of your foot and ankle surgery we are able to decrease the pain perceived after surgery and decrease the risk of chronic pain. During surgical intervention, meticulous handling of your soft tissue and bone while we correct your bunion, arthritis, or other deformities, helps to decrease pain after surgery as well. Immediately following surgery, a postoperative ankle block with local anesthesia is administered and limited bandaging is utilized to keep you comfortable. Two hours after surgery and before the anesthetic block wears off, the following regimen is started for most patients:*
- Tylenol 650 mg taken with Ibuprofen 600 mg every 8 hours (taken even if you do not have pain) for 7-10 days
- Gabapentin 100mg taken every 8 hours for 5 days (a nerve pain medication)
- Limited narcotics are prescribed and most of the time very few pills are needed for breakthrough pain.
The pre and post-operative local anesthetic block received during your foot and ankle surgery decreases pain at the level of the Central Nervous System (CNS). Tylenol and Ibuprofen (NSAIDS) inhibit the initiation of inflammation and the pain cascade. Gabapentin works on nerves to decrease pain signals. The additive effects of these medications is what contributes to the success of keeping pain minimal. Oxycodone is used only as needed for breakthrough pain and typically only 2-3 pills are utilized on average by patients. By using a combination of other therapies, the negative side effects of opioids (narcotics) including nausea, vomiting, sedation, constipation, and respiratory depression can be avoided.
With this multimodal pain management regimen, your foot and ankle physician is able to have you return to range of motion exercises and weight-bearing earlier. This also leads to improved recovery, decreased pain and avoidance of negative side effects from immobilization, such as excessive muscle loss and risk of a blood clot.
In conclusion, the Foot & Ankle Center of Iowa employs a multimodal pain management regimen to help decrease the typical postoperative pain and improve patient satisfaction with their foot and ankle surgery. This allows you to return to weight bearing sooner and avoid negative side effects of immobilization and opioids. Contact Foot & Ankle Center of Iowa for an appointment.
*This regimen must be reviewed with your foot and ankle surgeon prior to starting to ensure there are no issues with taking the medications, such as allergies, other drug interactions, and other health conditions that may make it unsafe to use this protocol.