Standardized Multimodal Pain Protocol Minimizes Inpatient Opioid Administration in Pediatric Orthopedic Surgery...

Area of Science:

• Orthopedic Surgery
• Pain Management
• Public Health

Background:

• Optimal post-operative pain management is crucial in orthopedic surgery.
• Concerns regarding opioid prescribing habits are rising due to the opioid epidemic.
• Lack of standardized protocols contributes to errors and excessive narcotic prescribing.

Purpose of the Study:

• To assess opioid use trends in pediatric orthopedic surgery patients.
• To document prescribing patterns before and after implementing a standardized protocol.

Main Methods:

• A multimodal postoperative pain pathway was developed and implemented.
• Electronic medical records of 455 pediatric orthopedic surgery patients (under 18) from Jan 2016 to June 2018 were analyzed.
• Procedures were categorized by complexity, and average opioid administration (in morphine milligram equivalents) was calculated and analyzed.

Main Results:

• Opioid administration was significantly higher in high-complexity procedures compared to low-complexity ones.
• The multimodal pain pathway significantly reduced opioid administration in both complexity groups.
• No increase in the length of hospital stay was observed after pathway implementation.

Conclusions:

• A standardized, multimodal pain regimen significantly decreases narcotic administration post-inpatient orthopedic surgery.
• This approach effectively manages post-operative pain without prolonging hospital stays.
• Evidence Level: IV.