Opiate Prescribing Practices After Common Isolated Lower Extremity Injuries

Rodriguez-Buitrago, Andres; Attum, Basem; Enata, Nichelle; Evans, Adam; Okwumabua, Ebubechi; Gajari, Vamshi; Obremskey, William T.; Jahangir, A. Alex

doi:10.1097/bot.0000000000001375

Cited by 15 publications

(11 citation statements)

References 23 publications

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“…Five studies [ 7 , 9 , 21 – 23 ] reported the incidence of adverse effects. Pooled results showed that ibuprofen group had 41% lower risk of adverse events than control group (RR = 0.59; 95% CI, 0.45 to 0.79; I 2 = 21%; P = .0002) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Traditionally, opioids are commonly prescribed for pain relief after acute injuries [23] . Unfortunately, opioids may lead to significant adverse events (e.g., somnolence, delirium, respiratory depression, abuse, dependence and addiction), creating a need for better alternatives [21] .…”

Section: Discussionmentioning

confidence: 99%

“…[25] Traditionally, opioids are commonly prescribed for pain relief after acute injuries. [23] Unfortunately, opioids may lead to significant adverse events (e.g., somnolence, delirium, respiratory depression, abuse, dependence and addiction), creating a need for better alternatives. [21] Several studies demonstrate that NSAIDs provide analgesia comparable to that of opioids for both adult and pediatric patients with musculoskeletal injuries.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of ibuprofen in children with musculoskeletal injuries

Jin¹,

Wang²,

Wang³

et al. 2021

Medicine

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Objective: To evaluate the analgesic efficacy and safety of ibuprofen in children with musculoskeletal injuries. Methods: PubMed, EMBASE, Web of science, and the Cochrane Central register of Controlled Trials (CENTRAL) were systematically searched to identify eligible randomized controlled trials (RCTs) that compared ibuprofen with other analgesics for pain relief in children with musculoskeletal injuries. Primary outcomes included change of visual analog scale (VAS) scores from baseline to post-medication, the proportion of patients achieving adequate analgesia, and the proportion of patients requiring additional analgesia. Secondary outcome was the incidence of adverse effects. Data analysis was performed using RevMan 5.3 software. Results: Five RCTs involving 1034 patients were included in this meta-analysis. Compared to the control group, change of VAS scores was greater in ibuprofen group at 60 min (standardized mean difference [SMD] = 0.28; 95% confidence intervals [CI], 0 to 0.57; P = .05), 90 min (SMD = 0.38; 95% CI, 0.17 to 0.59; P = .0005), and 120 min (SMD = 0.4; 95% CI, 0.23 to 0.57; P < .00001) after treatment. No difference was found in the change of VAS scores at 30 min (SMD = 0.07; 95% CI, -0.08 to 0.22; P = .36) after treatment. The proportion of patients who received adequate analgesia was higher in the ibuprofen group (risk ratios [RR] = 1.36; 95% CI, 1.20 to 1.56; P < .00001). The proportion of patients that required additional analgesia was lower in the ibuprofen group (RR = 0.7; 95% CI, 0.53 to 0.92; P = .01). The incidence of total adverse effects was lower in the ibuprofen group (RR = 0.59; 95% CI, 0.45 to 0.79; P = .0002). Conclusions: Ibuprofen provides a better pain relief with a lower incidence of adverse effects in children with musculoskeletal injuries as compared to other analgesics. PROSPERO registration number: CRD42021231975.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of ibuprofen in children with musculoskeletal injuries

Jin¹,

Wang²,

Wang³

et al. 2021

Medicine

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“…The benefits of delayed compared to those of early treatment of a tibial pilon fracture are deemed to include a clean and stable fracture environment for reduction, control of soft tissue swelling and local hematoma, and ensuring adequate microcirculation of the middle and lower segments of the tibia to support fracture healing and recovery of local soft tissues, including function of the tibial nerve[ 10 ]. Previous studies have reported a shorter time to fracture healing and full weight-bearing, as well as a reduced risk of fracture non-union, with delayed compared to early fracture reduction and internal fixation[ 11 , 12 ]. Our findings indicate that factors other than the time of surgery, namely the fracture type, the presence/absence of wound contamination, type of incision used, and health comorbidities influence the risk postoperative infection.…”

Section: Discussionmentioning

confidence: 99%

Identification of risk factors for surgical site infection after type II and type III tibial pilon fracture surgery

Hu¹,

Zhang²,

Xie³

et al. 2022

WJCC

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BACKGROUND High-energy tibial pilon fractures are complex and severe fractures that are associated with a high risk of infection following open reduction and internal fixation. Infection can negatively impact patient outcomes. AIM To compare risk factors for postoperative infection after open reduction and internal fixation for a pilon fracture. METHODS Among the 137 patients included, 67 developed a surgical site infection. Demographic, clinical, and surgical factors were compared between the two groups. A binary logistic regression analysis was used to determine the odds ratio (OR) and corresponding 95%CI for significant risk factors for postoperative infection. RESULTS The distribution of pathogenic bacteria among the 67 patients who developed a surgical site infection was as follows: Gram-positive, 58.2% ( n = 39); Gram-negative, 38.8% ( n = 26); and fungal, 2.9% ( n = 2). The following factors were associated with postoperative infection ( P < 0.05): a Ruedi–Allgower pilon fracture type III (OR = 2.034; 95%CI: 1.109–3.738); a type III surgical incision (OR = 1.840; 95%CI: 1.177–2.877); wound contamination (OR = 2.280; 95%CI: 1.378–3.772); and diabetes as a comorbidity (OR = 3.196; 95%CI: 1.209–8.450). CONCLUSION Infection prevention for patients with a Ruedi–Allgower fracture type III, surgical incision type III, wound contamination, and diabetes lowers the postoperative infection risk after surgical management of tibial pilon fractures.

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“…13 Plateau fractures also frequently have associated soft tissue compromise, including injuries to the menisci, collateral, and cruciate ligaments. 14,15 Patient-specific risk factors for increased and/or prolonged postoperative opioid use include patients with bicondylar tibial plateau fractures, 16 external fixation, and intra-articular fracture. 17 There is currently a dearth of literature evaluating the impact of RA on longitudinal perioperative and postoperative opioid demand in tibial plateau fractures.…”

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confidence: 99%

Regional Anesthesia Associated With Decreased Inpatient and Outpatient Opioid Demand in Tibial Plateau Fracture Surgery

Cunningham

LaRose

Zhang

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Regional anesthesia (RA) has been used to reduce pain and opioid usage in elective orthopedic surgery. The hypothesis of this study was that RA would be associated with decreased opioid demand in tibial plateau fracture surgery. METHODS: Inpatient opioid consumption and 90-day outpatient opioid prescribing in all patients ≥18 years of age undergoing tibial plateau fracture surgery from July 2013 to July 2018 (n = 264) at a single, level I trauma center were recorded. The presence or absence of perioperative RA was noted. Of 60 patients receiving RA, 52 underwent peripheral nerve blockade (PNB) with single-shot sciatic-popliteal (40.0%; n = 24), femoral (26.7%; n = 16), adductor canal (18.3%; n = 11), or fascia iliaca (1.7%; n = 1) block with ropivacaine. Ten patients received epidural analgesia (EA) with either single-shot spinal (11.7%; n = 7) blocks or continuous epidural (5.0%; n = 3). Additional baseline and treatment characteristics were recorded, including age, sex, race, body mass index (BMI), smoking, chronic opioid use, American Society of Anesthesiologists (ASA) score, injury mechanism, additional injuries, open injury, and additional inpatient surgery. Statistical models, including multivariable generalized linear models with propensity score weighting to adjust for baseline patient and treatment characteristics, were used to assess perioperative opioid demand with and without RA. RESULTS: RA was associated with reduced inpatient opioid usage from 0 to 24 hours postoperatively of approximately 5.2 oxycodone 5-mg equivalents (0.74 incident rate ratio [IRR]; 0.63–0.86 CI; P < .001) and from 24 to 48 hours postoperatively of approximately 2.9 oxycodone 5-mg equivalents (0.78 IRR; 0.64–0.95 CI; P = .014) but not at 48 to 72 hours postoperatively. From 1 month preoperatively to 2 weeks postoperatively, RA was associated with reduced outpatient opioid prescribing of approximately 24.0 oxycodone 5-mg equivalents (0.87; 0.75–0.99; P = .044) and from 1 month preoperatively to 90 days postoperatively of approximately 44.0 oxycodone 5-mg equivalents (0.83; 0.71–0.96; P = .011), although there was no significant difference from 1 month preoperatively to 6 weeks postoperatively. There were no cases of acute compartment syndrome in this cohort. CONCLUSIONS: In tibial plateau fracture surgery, RA was associated with reduced inpatient opioid consumption up to 48 hours postoperatively and reduced outpatient opioid demand up to 90 days postoperatively without an associated risk of acute compartment syndrome. RA should be considered for patients undergoing tibial plateau fracture fixation.

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Opiate Prescribing Practices After Common Isolated Lower Extremity Injuries

Cited by 15 publications

References 23 publications

Efficacy and safety of ibuprofen in children with musculoskeletal injuries

Efficacy and safety of ibuprofen in children with musculoskeletal injuries

Identification of risk factors for surgical site infection after type II and type III tibial pilon fracture surgery

Regional Anesthesia Associated With Decreased Inpatient and Outpatient Opioid Demand in Tibial Plateau Fracture Surgery

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