Abstract
Purpose
To determine the effect of the Orthopaedic Trauma Association (OTA) pain management guidelines for acute musculoskeletal injuries on opioid prescription sizes, pain control, and refills.
Methods
A prospective cohort study was performed at an academic urban level 1 trauma center. 90 patients undergoing outpatient orthopaedic trauma surgery were enrolled before and after the implementation of the OTA pain management guidelines. Adherence to guidelines, pain visual analog scale, and refills were recorded postoperatively and at the 2- and 6-week follow-up visit.
Results
After implementation of the guidelines, the number of patients receiving oxycodone decreased from 100 to 27%, with these patients receiving the less potent hydrocodone, instead. The discharge morphine equivalent dose (MED) decreased from a median (interquartile range) of 225 (169–300) to 140 mg (140–210) (p < 0.001). More patients required refills in the guidelines group (42% vs. 20%), resulting in no difference in total MED prescribed (210 (140–280) vs. 225 (169–307)). Adherence to the guidelines occurred in 66% of patients. As-treated analysis of patients with adherent and non-adherent prescriptions found no detectable difference in pain control, number of opioid pills used, or refills at the 2-week and 6-week follow-up.
Conclusions
In the midst of a national opioid crisis, adoption of the OTA’s pain management guidelines for orthopaedic trauma surgery warrants further research to determine if it’s implementation can reduce the size, variability, and duration of opioid prescriptions.
Level of evidence
Level II, prospective cohort.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no specific disclosures related to this study.
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Cyril Mauffrey has the following disclosures: Abbott: Other financial or material support; Carbofix: Research support; Current Opinion in Orthopaedics: Editorial or governing board; DePuy, A Johnson & Johnson Company: Other financial or material support; International Orthopaedics: Editorial or governing board; La Societe Internationale de Chirurgie Orthopedique et de Traumatologie: Board or committee member; Orthopaedic Trauma Association: Board or committee member; osteomed: Research support; Patient safety in surgery: Editorial or governing board; Springer: Publishing royalties, financial or material support; Stryker: Paid consultant; Unpaid consultant; The European journal of orthopaedic surgery and traumatology: Editorial or governing board. Joshua Parry has the following disclosures: The European journal of orthopaedic surgery and traumatology: Editorial or governing board. None of the remaining authors have anything to disclose.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with human participants or animals performed by any of the authors.
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Chambers, L., Jaynstein, J., Parry, J.A. et al. The effect of the orthopaedic trauma association’s (OTA) pain management guidelines on opioid prescriptions, pain control, and refills in outpatient orthopaedic trauma surgery. Eur J Orthop Surg Traumatol 32, 237–242 (2022). https://doi.org/10.1007/s00590-021-02951-z
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DOI: https://doi.org/10.1007/s00590-021-02951-z