Effect of a Multimodal Analgesic Protocol on Short-Term and Long-Term Opioid Use After Orthopaedic Trauma

Oyler, Douglas R.; Slade, Emily; Slavova, Svetla; Matuszewski, Paul E.; Lei, Feitong; Herndon, Brooke; Johnson, Shannon; Moghadamian, Eric S

doi:10.1097/bot.0000000000002346

Cited by 6 publications

(4 citation statements)

References 36 publications

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“…Walker et al found that a multimodal postoperative analgesia protocol, which included the use of either diazepam or methocarbamol, reduced opioid consumption, improved pain control, and resulted in shorter hospital stays following posterior lumbar fusion surgery 33 . A similar study in orthopaedic trauma patients also found that patients assigned to a multimodal analgesia protocol, which included methocarbamol, had less opioid use postoperatively 34 . To our knowledge, there are currently no studies that have directly evaluated muscle relaxants in the postoperative period following spine surgery or orthopaedic surgery in general.…”

Section: Gaba(a) Subunitmentioning

confidence: 75%

Benzodiazepines and Related Drugs in Orthopaedics

Hozack

Kistler

Vaccaro

et al. 2022

Journal of Bone and Joint Surgery

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Benzodiazepines are among the most commonly prescribed drugs worldwide and are often used as anxiolytics, hypnotics, anticonvulsants, and muscle relaxants.The risk of dependence on and abuse of these medications has recently gained more attention in light of the current opioid epidemic.Benzodiazepines can increase the risk of prolonged opioid use and abuse.Given the prevalence of the use of benzodiazepines and related drugs, orthopaedic patients are often prescribed these medications.Orthopaedic surgeons need to be aware of the prevalence of benzodiazepine and related drug prescriptions in the general population, their current uses in orthopaedic surgery, and the risks and adverse effects of their use.

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Section: Gaba(a) Subunitmentioning

confidence: 75%

Benzodiazepines and Related Drugs in Orthopaedics

Hozack

Kistler

Vaccaro

et al. 2022

Journal of Bone and Joint Surgery

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“…However, increased inpatient opioid use among orthopaedic patients is associated with greater pain, less satisfaction with pain control, and continued chronic opioid use. 10,[39][40][41][42] Given the significant variability that exists in opiateprescribing practices after orthopaedic injury, the lack of universal opiate-prescribing recommendations, and the rising rates of opioid-related deaths as seen in the current opioid epidemic, 43,44 changes in pain management after musculoskeletal injury are necessary, especially in polytrauma patients who may be at increased risk of developing chronic pain and opioid use. 45,46 The lower extremity assessment project study showed that inadequate pain control in the early recovery period after high-energy lower extremity trauma was the largest predictor of long-term chronic pain 7 years postinjury.…”

Section: Discussionmentioning

confidence: 99%

“…MMA is the current recommendation of the Orthopaedic Trauma Association Musculoskeletal Pain Task Force because it is associated with reductions in both short-term and long-term opioid use after orthopaedic trauma. [9][10][11] Despite a recent push for MMA, orthopaedic surgeons may be hesitant to use NSAIDs in fracture patients because of concern for bone healing. However, withholding NSAIDs may also cause harm by increasing narcotic requirements in patients.…”

Section: Introductionmentioning

confidence: 99%

“…12,13 Although some studies have shown opioids to be more efficacious analgesics compared with NSAIDs, adding NSAIDs to opioid treatment has been shown to reduce opioid requirements and opioid-related side effects. 10,14,15 Therefore, NSAIDs may serve as a promising adjuvant for obtaining perioperative and postoperative musculoskeletal pain control.…”

Section: Introductionmentioning

confidence: 99%

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Low-Dose Short-Term Scheduled Ketorolac Reduces Opioid Use and Pain in Orthopaedic Polytrauma Patients: A Randomized Clinical Trial

Foster,

Kavolus,

Landy

et al. 2023

Journal of Orthopaedic Trauma

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Objective: To determine whether scheduled low-dose, short-term ketorolac is associated with reduced length of stay, opioid use, and pain in orthopaedic polytrauma patients. Design: Double-blinded, randomized controlled trial Setting: One Level 1 trauma center Patients: From August 2018 to October 2022, 70 orthopaedic polytrauma patients between 18-75 years-old with a New Injury Severity Score (NISS) > 9 were randomized. 70 participants were enrolled, with 35 randomized to the ketorolac group and 35 to the placebo group. Intervention: 15 mg of intravenous (IV) ketorolac every 6 hours for up to 5 inpatient days or 2 mL of IV saline in a similar fashion Main Outcome Measurements: Length of Stay (LOS), Morphine Milligram Equivalents (MME), Visual Analogue Scale (VAS), and Complications Results: Study groups were not significantly different with respect to age, BMI, and NISS (p>0.05). Median LOS was 8 days (interquartile range [IQR], 4.5 to 11.5) in the ketorolac group compared to 7 days (IQR, 3 to 10) in the placebo group (p = 0.275). Over the 5-day treatment period, the ketorolac group experienced a 32% reduction in average MME (p = 0.013) and a 12-point reduction in baseline-adjusted mean VAS (p = 0.037) compared to the placebo group. There were no apparent short-term adverse effects in either group. Conclusion: Scheduled low-dose, short-term IV ketorolac was associated with significantly reduced inpatient opioid use and pain in orthopaedic polytrauma patients with no significant difference in LOS and no apparent short-term adverse effects. The results support the use of scheduled low-dose, short-term IV ketorolac for acute pain control among orthopaedic polytrauma patients. Further studies are needed to delineate lasting clinical effects and potential long-term effects, such as fracture healing. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Perioperative Opioid Management Strategies: Do They Make a Difference in Long-Term Health Outcomes?

Ye,

Li,

Mariano

2023

Curr Anesthesiol Rep

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Effect of a Multimodal Analgesic Protocol on Short-Term and Long-Term Opioid Use After Orthopaedic Trauma

Abstract: Objective: To determine whether the use of a multimodal analgesic protocol reduced short-term and long-term opioid use in patients hospitalized after orthopaedic trauma.

Cited by 6 publications

References 36 publications

Benzodiazepines and Related Drugs in Orthopaedics

Benzodiazepines and Related Drugs in Orthopaedics

Low-Dose Short-Term Scheduled Ketorolac Reduces Opioid Use and Pain in Orthopaedic Polytrauma Patients: A Randomized Clinical Trial

Perioperative Opioid Management Strategies: Do They Make a Difference in Long-Term Health Outcomes?

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