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Updated: Jun 26, 2025
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Author Spotlight: Regenerative Peripheral Nerve Interface (RPNI) Surgery in Postamputation Pain Management
Published on: March 15, 2024
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Postoperative Opioid-Prescribing Practice in Limb Preservation Surgery
Brandon M Brooks1,2, Chia-Ding Shih3, Reed W R Bratches1
1*The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH.
Summary
Podiatric physicians use nerve blocks more than opioids for limb preservation surgery. Regional practice variations exist, and physicians can help curb the opioid epidemic by prescribing non-opioid pain relief.
Area of Science:
- Podiatric surgery
- Pain management
- Public health
Background:
- Limb preservation surgery impacts over 100,000 Americans annually.
- Postoperative pain management prescribing practices of podiatric physicians are understudied.
- This study examines opioid prescribing for limb preservation surgery.
Purpose of the Study:
- To investigate the postoperative pain management prescribing practices of podiatric physicians in the United States.
- To identify prescriber characteristics associated with opioid prescribing for limb preservation surgery.
Main Methods:
- An anonymous online questionnaire with five surgical scenarios was administered to 115 podiatric physicians.
- Prescription choices and provider demographics were collected.
- Linear and logistic regression models analyzed associations between prescriber characteristics and opioid quantities/odds.
Main Results:
- Podiatric physicians reported using regional nerve blocks (70%-88%) more than prescribing opioids (43%-67%).
- Opioids were prescribed more frequently than NSAIDs and anticonvulsants.
- Practicing in the Northeast US was associated with lower opioid prescribing for transmetatarsal amputations.
Conclusions:
- Significant regional variation exists in limb preservation surgery prescribing practices.
- Podiatric physicians utilize regional nerve blocks more than postoperative opioids.
- Podiatric physicians can mitigate the opioid epidemic by promoting preventive foot care and non-opioid analgesics.
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