Related Experiment Video
Updated: Oct 10, 2025
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Multimodal analgesia reduces opioid requirements in trauma patients with rib fractures
Shakira W Burton1, Christina Riojas, Gail Gesin
1From the Acute Care Surgery Division (S.W.B., C.R., C.B.S., V.B., C.W.L.), Atrium Health-Carolinas Medical Center; Division of Pharmacy (G.G.), FH Sammy Ross Trauma Center (R.S.), Atrium Health; Department of Orthopaedic Surgery (T.R., M.K.W., M.J.B., J.R.H., D.L., S.O., R.B.S., Z.Y.), Atrium Health Musculoskeletal Institute; NC Poison Control (M.B.), Department of Emergency Medicine (M.G., C.G., M.R.), Patient Safety (S.J.), Atrium Health; OrthoCarolina Research Institute (S.O.); Department of Internal Medicine (A.S.), Atrium Health Information and Analytic Services (D.M.S.), Atrium Health, Charlotte; GIV Hydration (B.W.), Huntersville; and Adult Psychiatry, Atrium Health (S.W.), Charlotte, NC.
Background:
Rib fractures are common in trauma patients and are associated with significant morbidity and mortality. Adequate analgesia is essential to avoid the complications associated with rib fractures. Opioids are frequently used for analgesia in these patients. This study compared the effect of a multimodal pain regimen (MMPR) on inpatient opioid use and outpatient opioid prescribing practices in adult trauma patients with rib fractures.
Study Design:
A pre-post cohort study of adult trauma patients with rib fractures was conducted at a Level I trauma center before (PRE) and after (POST) implementation of an MMPR. Patients on long-acting opioids before admission and those on continuous opioid infusions were excluded. Primary outcomes were oral opioid administration during the first 5 days of hospitalization and opioids prescribed at discharge. Opioid data were converted to morphine milligram equivalents (MMEs).
Results:
Six hundred fifty-three patients met inclusion criteria (323 PRE, 330 POST). There was a significant reduction in the daily MME during the second through fifth days of hospitalization; and the average inpatient MME over the first five inpatient days (23 MME PRE vs. 17 MME POST, p = 0.0087). There was a significant reduction in the total outpatient MME prescribed upon discharge (322 MME PRE vs. 225 MME POST, p = 0.006).
Conclusion:
The implementation of an MMPR in patients with rib fractures resulted in significant reduction in inpatient opioid consumption and was associated with a reduction in the quantity of opiates prescribed at discharge.
Level Of Evidence:
Therapeutic/Care Management; level IV.
Related Concept Videos
01:25Analgesia and Pain Management
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
01:20Opioid Analgesics: Morphine and Other Natural Cogeners
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia