Effectiveness of Multimodal Pain Therapy on Reducing Opioid Use in Surgical Geriatric Hip Fracture Patients

Abstract

Background: There is a need for appropriate pain control in the geriatric hip fracture population to prevent diminished function, increased mortality, and opioid dependence. Multimodal pain therapy is one method for reducing pain postoperatively while also decreasing opioid use in the geriatric hip fracture patient. This study aimed to determine whether multimodal pain therapy could decrease opioid use without increasing pain scores in surgical geriatric hip fracture patients. Methods: This was a before-and-after cohort study. The hospital implemented multimodal pain control order sets with a standardized pain regimen and performed retrospective chart review pre- and postorder set implementation for analysis. Results: A total of 248 patients were enrolled in the study: 131 in the preorder set group and 117 in the postorder set group. The mean postoperative oral morphine equivalent (OME) was significantly lower in the postorder set group than in the preorder set group (45.1 mg vs. 63.4 mg, respectively, p = .03). Compared with the preorder set group, total OME and postoperative OME were decreased by 22.6% (95% confidence interval [CI] −44.9, −3.8), 1-tailed p < .01, and 53.6% (95% CI −103.4, −16.1), 1-tailed p <.01 respectively, in the postorder set group. There was not a statistically significant difference in mean pain scores at 6, 24, and 48 hr postoperatively (p = .53, .10, and .99), respectively. Conclusion: Implementing a multimodal approach to pain management may help reduce opioid use and may be a critical maneuver in averting the national opioid epidemic.

Original Research: Combating the Opioid Epidemic Through Nurse Use of Multimodal Analgesia: An Integrative Literature Review

“…Three smaller-scale retrospective studies contributed further useful findings. Bollinger and colleagues25 and Girardot and colleagues27 each conducted retrospective studies among patients undergoing orthopedic procedures. Warren and colleagues conducted a retrospective review of patients undergoing open ventral hernia repair 30…”

“…They found that doing so significantly reduced total postoperative narcotic use: patients who received perioperative IV acetaminophen used an average of 28.3 mg of opioids following surgery compared with an average of 41.3 mg among patients who did not. And in a before-and-after cohort study among 248 patients undergoing surgery for hip fracture, Girardot and colleagues explored the use of a standardized order set calling for 1,000 mg of oral acetaminophen before surgery and up to three doses following surgery as a first-line treatment 27. Such use was found to reduce total postoperative oral opioid use by 22.6%.…”

“…And in a before-and-after cohort study among 248 patients undergoing surgery for hip fracture, Girardot and colleagues explored the use of a standardized order set calling for 1,000 mg of oral acetaminophen before surgery and up to three doses following surgery as a first-line treatment. 27 Such use was found to reduce total postoperative oral opioid use by 22.6%.…”

“…Of the 13 studies, nine were conducted either in U.S. hospitals (randomized controlled trials) 20,22,23 or using U.S. hospital databases (retrospective cohort or population-based studies). [25][26][27][28][29][30] Three randomized controlled trials took place outside the United States, including single-site trials conducted in Denmark 24 and in Turkey 19 and a multisite trial conducted at nine hospitals in Spain. 21 The qualitative study was conducted at a single hospital in Sweden.…”

“…The opioid-sparing pharmacological interventions covered in this review have been shown not only to reduce opioid use, but also to improve pain scores while decreasing patients' risk of many opioid-related complications. Hospital leaders may want to consider the development of standardized order sets or protocols that include multimodal analgesia strategies, 27 as well as the use of a clinical decision aid that assists in their use. 38 The MOSS tool shows promise, and further research is recommended.…”