Factors Affecting Upper Limb Fracture Opioid Requirements

Area of Science:

• Orthopedic Surgery
• Pain Management
• Pharmacology

Background:

• Understanding opioid requirements for upper limb fractures is crucial for evidence-based guidelines and opioid stewardship.
• Patient-specific factors influence pain relief needs, necessitating tailored prescribing strategies.

Purpose of the Study:

• To investigate predictors of opioid requirements in patients with upper limb fractures.
• To analyze fracture location, demographics, and comorbidities as factors influencing opioid consumption.

Main Methods:

• Retrospective analysis of 9125 upper limb fractures (shoulder to wrist) from 2015-2022.
• Calculation of monthly morphine milligram equivalents (MMEs) for the first post-injury year.
• Assessment of opioid coverage (days medicated) and strength (MME) based on injury characteristics and patient comorbidities.

Main Results:

• Scapula, proximal humerus, humeral shaft, distal humerus, and proximal ulna fractures showed significantly higher MME requirements.
• Radius shaft and distal radius fractures had lower MME requirements.
• Comorbidities including depression, diabetes, drug abuse history, obesity, pulmonary circulatory disorder, and rheumatological conditions were associated with increased opioid strength and/or coverage.

Conclusions:

• Fractures of the scapula, proximal humerus, and humeral shaft are linked to increased opioid strength and coverage.
• Depression, pulmonary disease, and rheumatological conditions significantly increase opioid strength and coverage needs.
• This study provides a framework for anticipating rehabilitation trajectories and risk stratification for upper limb fractures.