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Pain Management in Staged Osseointegration Procedures: A Retrospective Study and Foundation for Future Optimization
Margaret L McCarthy1,2, Ren M Ariizumi2,3, Ana G Grajales4
1Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
Military Medicine
|June 22, 2024
Summary
Perioperative pain management for osseointegration (OI) procedures varied, with epidurals and ketamine commonly used. Optimizing analgesia care is needed as OI becomes more accessible.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Prosthetics
Background:
- Osseointegration (OI) improves prosthetic function but perioperative pain management is understudied.
- Conventional socket prosthetics have functional limitations compared to OI.
- Research has primarily focused on functional outcomes, not pain control.
Purpose of the Study:
- To describe perioperative and postoperative pain management strategies for osseointegration (OI) patients.
- To analyze pain management approaches at a tertiary medical center.
- To identify variability in pain management during OI procedures.
Main Methods:
- Retrospective review of 41 patients undergoing 76 staged OI procedures (2016-2021).
- Data collected on perioperative and postoperative pain management interventions.
- Analysis of pain scores and interventions by acute pain services.
Main Results:
- Common analgesia included ketamine, epidurals (3-4 days), and peripheral nerve catheters.
- Median intraoperative opioid dose was 65 mg; 54-56% required PACU opioids.
- 15% required epidural/catheter adjustments, 8% had dislodged catheters, 36% needed acute pain service intervention.
Conclusions:
- Significant variability exists in pain management requirements for OI patients.
- Opportunities exist to optimize analgesia care and conduct patient-centered research.
- As OI accessibility increases, tailored pain management strategies are crucial.
