Opioid Prescribing Practices by Orthopaedic Trauma Surgeons After Isolated Femur Fractures

Attum, Basem; Rodriguez-Buitrago, Andres; Harrison, Nichelle; Evans, Adam; Obremskey, William T.; Sethi, Manish K.; Jahangir, A. Alex

doi:10.1097/bot.0000000000001046

Cited by 26 publications

(38 citation statements)

References 18 publications

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“…Prescribing guidelines for those with prior opioid use remains challenging and requires further study. (29) Our method for identifying prior opioid use and opioid naïve patients may be an underestimate since our data spans a time period not completely covered by the Massachusetts Prescription Monitoring Program, but our incidence rate is consistent with prior reports. (11) Opioid prescribing data for multi-system trauma or those with multiple fractures also requires further research.…”

Section: Limitationssupporting

confidence: 82%

Using Historical Variation in Opioid Prescribing Immediately After Fracture Surgery to Guide Maximum Initial Prescriptions

Bhashyam

Basilico

Weaver

et al. 2019

Journal of Orthopaedic Trauma

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Objectives: Recent studies have advocated for prescription opioid maximums (based on percentage reductions from historical amounts) to reduce excess prescribing. (1) Implementing this in orthopaedic trauma has been difficult given injury variety and limited historical data on postoperative prescribing. We report on the initial opioid prescriptions for a large cohort of postoperative, opiate-naïve fracture patients and hypothesize that prescribing was associated with fracture location and morphology. Design: Retrospective cohort analysis Setting: Two ACS level I trauma centers Patients: 6,879 orthopaedic trauma patients treated between 2002-2015. Only patients who had a single operatively-treated injury and were opiate-naive (had not received an opioid prescription in the 6 months prior to presentation) were included.

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Section: Limitationssupporting

confidence: 82%

Using Historical Variation in Opioid Prescribing Immediately After Fracture Surgery to Guide Maximum Initial Prescriptions

Bhashyam

Basilico

Weaver

et al. 2019

Journal of Orthopaedic Trauma

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“…[4][5][6] However, opiates remain the default choice for most orthopedic providers across North America, with deeply ingrained practice patterns leading to routine prescription of opioids following a fracture, surgery, or worsening degenerative bone and joint disease. [7][8][9] On October 17, 2018, Canada became the second country to legalize both recreational and medical use of Cannabis. Surrounding this decision, the spotlight was on the evidence for efficacy and harms associated with use of cannabinoids across an array of medical indications.…”

Section: Clinical Medicine Insights: Arthritis and Musculoskeletal DImentioning

confidence: 99%

“…4-6 However, opiates remain the default choice for most orthopedic providers across North America, with deeply ingrained practice patterns leading to routine prescription of opioids following a fracture, surgery, or worsening degenerative bone and joint disease. 7-9…”

Section: Introductionmentioning

confidence: 99%

Cannabinoids in Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis

Johal

Devji²,

Chang³

et al. 2020

Clin Med�Insights�Arthritis�Musculoskelet Disord

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Background: For patients with chronic, non-cancer pain, traditional pain-relieving medications include opioids, which have shown benefits but are associated with increased risks of addiction and adverse effects. Medical cannabis has emerged as a treatment alternative for managing these patients and there has been a rise in the number of randomized clinical trials in recent years; therefore, a systematic review of the evidence was warranted. Objective: To analyze the evidence surrounding the benefits and harms of medical cannabinoids in the treatment of chronic, non-cancer-related pain. Design: Systematic review with meta-analysis. Data sources: Medline, Embase, CINAHL, SCOPUS, Google Scholar, and Cochrane Databases. Eligibility criteria: English language randomized clinical trials of cannabinoids for the treatment of chronic, non-cancer-related pain. Data extraction and synthesis: Study quality was assessed using the Cochrane risk of bias tool. All stages were conducted independently by a team of 6 reviewers. Data were pooled through meta-analysis with different durations of treatment (2 weeks, 2 months, 6 months) and stratified by route of administration (smoked, oromucosal, oral), conditions, and type of cannabinoids. Main outcomes and measures: Patient-reported pain and adverse events (AEs). Results: Thirty-six trials (4006 participants) were included, examining smoked cannabis (4 trials), oromucosal cannabis sprays (14 trials), and oral cannabinoids (18 trials). Compared with placebo, cannabinoids showed a significant reduction in pain which was greatest with treatment duration of 2 to 8 weeks (weighted mean difference on a 0-10 pain visual analogue scale −0.68, 95% confidence interval [CI], −0.96 to −0.40, I2 = 8%, P < .00001; n = 16 trials). When stratified by route of administration, pain condition, and type of cannabinoids, oral cannabinoids had a larger reduction in pain compared with placebo relative to oromucosal and smoked formulations but the difference was not significant ( P[interaction] > .05 in all the 3 durations of treatment); cannabinoids had a smaller reduction in pain due to multiple sclerosis compared with placebo relative to other neuropathic pain ( P[interaction] = .05) within 2 weeks and the difference was not significant relative to pain due to rheumatic arthritis; nabilone had a greater reduction in pain compared with placebo relative to other types of cannabinoids longer than 2 weeks of treatment but the difference was not significant ( P[interaction] > .05). Serious AEs were rare, and similar across the cannabinoid (74 out of 2176, 3.4%) and placebo groups (53 out of 1640, 3.2%). There was an increased risk of non-serious AEs with cannabinoids compared with placebo. Conclusions: There was moderate evidence to support cannabinoids in treating chronic, non-cancer pain at 2 weeks. Similar results were observed at later time points, but the confidence in effect is low. There is little evidence that cannabinoids increase the risk of experiencing serious AEs, although non-serious AEs may be common in the short-term period following use.

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“…*Two of our 11 studies contained pertinent information to 2 of our PICOs (Attum et al 12 and Rodriguez-Buitrago et al 14 ). …”

Section: Resultsmentioning

confidence: 99%

“…Four of the 10 cohort studies that included information on prior opioid use within their population investigated both patients with a prior history of opioid use and those naive to opioids 11,12,14,16 . Three of these studies previously mentioned evaluated the differences in MME between opioid-naive and nonnaive patients 11,12,14 .…”

Section: Resultsmentioning

confidence: 99%

Postoperative opioid prescribing practices in US adult trauma patients: A systematic review

Rowe

Zagales

Fanfan

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Opioids have been proven effective in pain management, but overprescription can lead to addiction and abuse. Although current guidelines regarding opioid prescription for chronic and acute pain are available, they fail to address the use of opioids for pain management in traumatic injury patients who undergo operations. The primary objective of this study was to examine opioid prescribing practices for US adult trauma patients who require surgical management, based on prior history of opioid use, type of surgical practice, and age. METHODS:PubMed and Cochrane Journals were used to identify relevant articles between October 2010 and December 29, 2020. Our primary outcome was discrepancies of morphine milligram equivalents (MMEs) prescribed to trauma patients. Significance was defined as p < 0.05. RESULTS:Eleven studies on US trauma patients prescribed opioids were evaluated, creating a total of 30,249 patients stratified by prior opioid use, age, and race. Patterns seen among patients with prior opioid use include higher MMEs prescribed, lower likelihoods of opioid discontinuation, higher mortality rates, and higher complication rates. Orthopedic surgeons prescribed higher values of MMEs than nonorthopedic surgeons. CONCLUSION:Higher incidences of opioid prescriptions are seen with orthopedic trauma surgery and prior opioid use by the patient. We recommend further development of national protocol implementation for acute pain management for the US trauma population.

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Opioid Prescribing Practices by Orthopaedic Trauma Surgeons After Isolated Femur Fractures

Abstract: Patients with prior exposure are more likely to be prescribed more opiates after femoral shaft fracture treatment. We recommend a protocol of prescribing half the mean of MMEs currently prescribed by orthopedists equating to 47 (711 MMEs) pills of oxycodone 10 mg in up to 3 prescriptions.

Cited by 26 publications

References 18 publications

Using Historical Variation in Opioid Prescribing Immediately After Fracture Surgery to Guide Maximum Initial Prescriptions

Using Historical Variation in Opioid Prescribing Immediately After Fracture Surgery to Guide Maximum Initial Prescriptions

Cannabinoids in Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis

Postoperative opioid prescribing practices in US adult trauma patients: A systematic review

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