Abstract
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.
| Original language | English |
|---|---|
| Journal | Journal of Orthopaedic Trauma |
| DOIs | |
| State | E-pub ahead of print - Jan 6 2022 |
Bibliographical note
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.Funding
Supported by Grant No. 2018-PM-BX-K051 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the US Department of Justice's Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the SMART Office. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the US Department of Justice.