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ESRA19-0247 Review of acute pain management in patients with pre-existing chronic pain undergoing foot and ankle surgery: is the problem the solution?
  1. J Stewart,
  2. A Cormack and
  3. W Scott
  1. Glasgow Royal Infirmary, Anaesthetics, Glasgow, UK


Background and aims Regional anaesthesia (RA) is commonly employed for intra- and post-operative pain control in foot and ankle surgery (FAS). Optimal post-operative analgesia is fundamentally important as acute pain in the post-operative period is an independent risk factor for development of chronic pain (CP). Patients with CP often present unique challenges for acute pain management. A one-year retrospective analysis of patients undergoing elective FAS was performed to determine if post-operative pain control was suboptimal in patients with pre-existing CP, as well as the role of RA in their management.

Methods Retrospective review of electronic case notes of the patients undergoing elective FAS in large teaching hospital. Ethical approval was not required for service evaluation project.

Results 98 patients’ case notes were examined during the studied period (63% female, 37% male). 52% were on long-acting opioids or neuropathic medications pre-operatively. Within the CP subgroup, 88% received RA. 27% patients with CP required IV opioids in recovery, compared with 33% in the non-CP subgroup. Breakthrough opioid requirement was reduced in CP compared with non-CP subgroups (31% vs. 39%) whilst use of long-acting opioids post-operatively was higher in the CP subgroup (23% vs. 5% in non-CP subgroup; Chart 2).

Conclusions We found that post-operative pain management in our institution of patients with CP was comparable to those without CP. This was best achieved by continuation of pre-operative analgesia combined with the use of effective RA.

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