The effect of a multimodal analgesic protocol on short- and long-term opioid use after orthopaedic trauma

OBJECTIVE: To determine if use of a multimodal analgesic protocol reduced short- and long-term opioid use in patients hospitalized after orthopaedic trauma.

DESIGN: Retrospective pre-post intervention study.

SETTING: Regional, academic, level 1 trauma center in Central KentuckyPatients/Participants: Patients hospitalized after orthopaedic injury before (n=393) and after (n=378) implementation of a multimodal analgesic protocol.

INTERVENTION: A multimodal analgesic protocol consisting of acetaminophen, ibuprofen/ketorolac, gabapentinoids, skeletal muscle relaxants, and standardized doses of opioids, plus standardized pain management education prior to hospital discharge.

MAIN OUTCOME MEASUREMENTS: Endpoints included discharge opioid prescription, days' supply and daily morphine milligram equivalent (MME), and long-term opioid use after hospitalization.Opioid use in the 90 days before and after hospitalization was assessed using state prescription drug monitoring program data.

RESULTS: Discharge opioid prescription rates were similar in the intervention and control cohorts (79.9% vs. 78.4%, OR 1.30 (0.83-2.03), p=0.256). Patients in the intervention cohort received a shorter days' supply (5.7±4.1 days vs. 8.1±6.2 days, RR 0.70 (0.65-0.76), p<0.001) and lower average daily MME (34.8±24.9 MME vs. 51.5±44.0 MME, RR 0.68 (0.62-0.75), p<0.001). Incidence of long-term opioid use was also significantly lower in the intervention cohort (7.7% vs. 12.0%, OR 0.53 (0.28-0.98), p=0.044).

CONCLUSIONS: Implementation of a multimodal analgesic protocol was associated with reductions in both short- and long-term opioid use, including long-term opioid therapy, after orthopaedic trauma.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.