Evidence map›Paper›PMID 35581524›Full record

GuidelineCanadian journal of anaesthesia = Journal canadien d'anesthesie2022

Elective surgery in ankle and foot disorders-best practices for management of pain: a guideline for clinicians.

Derek Dillane, Ailar Ramadi, Stephanie Nathanail, Bruce D Dick, Geoff Bostick, Kitty Chan, Chris Douglas, Gordon Goplen, James Green, Susan Halliday and 6 more

Erratum issuedOpen access · bronzeAbstract readPractice Guideline
PubMed Publisher
In one paragraph

Guideline in Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.2field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 8 citations in OpenAlex.

  1. Trial
  2. Article
  3. The role of anesthesiologists in reducing opioid harm.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2022
    Article
  4. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

16 authors at 2 institutions in 1 country.

Derek DillaneDepartment of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Ailar RamadiDepartment of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
Stephanie NathanailCollaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada.
Bruce D DickDepartment of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Geoff BostickDepartment of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
Kitty ChanCollaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada.
Chris DouglasDepartment of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Gordon GoplenCollaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada.
James GreenDepartment of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Susan HallidayDepartment of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Braiden HellecPharmacy, Alberta Health Services, Edmonton, AB, Canada.
Saifee RashiqDepartment of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Angela ScharfenbergerCollaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada.
Guy WoolseyCollaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada.
Lauren A BeaupreDepartment of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada. lauren.beaupre@ualberta.ca.ORCID http://orcid.org/0000-0002-4770-991X
M Elizabeth PedersenCollaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada.
University of Alberta · CAAlberta Health Services · CA

Funding

Alberta Health Services Surgery Strategic Clinical Network RES0036918American Orthopaedic Foot and Ankle Society 2018-81-P
6 · The paper itself

Abstract

purposeComplex elective foot and ankle surgeries are often associated with severe pain pre- and postoperatively. When inadequately managed, chronic postsurgical pain and long-term opioid use can result. As no standards currently exist, we aimed to develop best practice pain management guidelines.

methodsA local steering committee (n = 16) surveyed 116 North American foot and ankle surgeons to understand the "current state" of practice. A multidisciplinary expert panel (n = 35) was then formed consisting of orthopedic surgeons, anesthesiologists, chronic pain physicians, primary care physicians, pharmacists, registered nurses, physiotherapists, and clinical psychologists. Each expert provided up to three pain management recommendations for each of the presurgery, intraoperative, inpatient postoperative, and postdischarge periods. These preliminary recommendations were reduced, refined, and sent to the expert panel and "current state" survey respondents to create a consensus document using a Delphi process conducted from September to December 2020.

resultsOne thousand four hundred and five preliminary statements were summarized into 51 statements. Strong consensus (≥ 80% respondent agreement) was achieved in 53% of statements including the following: postsurgical opioid use risk should be assessed preoperatively; opioid-naïve patients should not start opioids preoperatively unless non-opioid multimodal analgesia fails; and if opioids are prescribed at discharge, patients should receive education regarding importance of tapering opioid use. There was no consensus regarding opioid weaning preoperatively.

conclusionsUsing multidisciplinary experts and a Delphi process, strong consensus was achieved in many areas, showing considerable agreement despite limited evidence for standardized pain management in patients undergoing complex elective foot and ankle surgery. No consensus on important issues related to opioid prescribing and cessation highlights the need for research to determine best practice.

Indexed as

Analgesics, OpioidOpioid-Related DisordersAftercareAnkleHumansPatient DischargePostoperative PainPractice Patterns, Physicians'Analgesics, Opioidfoot and ankleguidelinesopioid usepainsurgery

Identifiers

PMID35581524
OpenAlexW4280491440

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.