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Postoperative Pain After Surgical Treatment of Ankle Fractures: A Prospective Study
Loretta B Chou1, Emily L Niu1, Ariel A Williams1
1Department of Orthopaedic Surgery, Stanford University, Redwood City, CA (Dr. Chou, Dr. Niu, Dr. Duester, and Dr. Harris); the Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD (Dr. Williams); and the Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO (Ms. Anderson and Dr. Hunt).
Background:
Postoperative pain after fixation of ankle fractures has a substantial effect on surgical outcome and patient satisfaction. Patients requiring large amounts of narcotics are at higher risk of long-term use of pain medications. Few prospective studies investigate patient pain experience in the management of ankle fractures.
Methods:
We prospectively evaluated the pain experience in 63 patients undergoing open reduction and internal fixation of ankle. The Short-Form McGill Pain Questionnaire was administered preoperatively and postoperatively (PP) at 3 days (3dPP) and 6 weeks (6wPP). Anticipated postoperative pain (APP) was recorded.
Results:
No significant differences were found between PP, APP, and 3dPP; however, 6wPP was markedly lower. Significant correlations were found between PP and APP and between preoperative and postoperative Short-Form McGill Pain Questionnaire scores. PP and APP were independent predictors of 3dPP; however, only APP was predictive of 6wPP. Sex, age, and inpatient versus outpatient status were not notable factors. No statistically significant differences were found in pain scores between fracture types.
Conclusions:
Both preoperative pain severity and anticipated postoperative pain are predictive of postoperative pain levels. Orthopaedic surgeons should place a greater focus on the postoperative management of patient pain and expectations after surgical procedures.
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