The role of a multidisciplinary approach to opioid reduction for patients with operatively treated upper extremity...

The aim of this study was to determine whether a multimodal program for opioid reduction in upper extremity fracture patients decreased (1) inpatient opioid consumption during post-operative days (PODs) 1-4 and (2) outpatient opioid prescription volume.

We conducted a retrospective comparative study of patients with isolated upper extremity fractures admitted to the inpatient orthopedic unit at an academic level 1 trauma center in 2018 and 2020 (pre- and post-program implementation). We calculated total inpatient opioid consumption (measured in morphine milligram equivalents [MMEs]) during POD 1-4 and from opioid prescriptions within 90 days postdischarge. Patients with multiple concurrent fractures, preinjury opioid use, or less than 90-day follow-up were excluded. Descriptive statistics in the form of frequencies (%) and means (standard deviation) were calculated. Linear mixed modeling with repeated measures revealing P values of .05 or lower was considered statistically significant. Multiple concurrent fractures were defined as bilateral upper extremity injuries, ipsilateral fractures involving separate regions (eg, hand and shoulder), or combined radius and ulna fractures. This modeling was used to evaluate independent predictors of opioid use, including age, American Society of Anesthesiologists class, fracture type, and gabapentin use.

A total of 128 patients with an operatively treated upper extremity fracture were identified (76 in 2018, 52 in 2020). No differences were seen in patient demographics. Pre-operative peripheral nerve block use was similar between groups (P = .570). Gabapentin was used in a significantly higher proportion of patients in 2020 than it was in 2018 (34% vs. 18.3%, P = .050). Inpatient opioid consumption significantly decreased from 2018 to 2020 (P = .003), most notably on POD 1 and 2, with age and American Society of Anesthesiologists class being significant predictors of opioid use (P = .0012 and P = .0315, respectively). Mean MMEs on POD 1 were 68.21 in 2018 vs. 50.32 in 2020, whereas mean MMEs on POD 2 were 46.76 in 2018 vs. 12.15 in 2020. Forty-six point zero five percentage of patients in 2018 were taking opioids on POD 2 vs. 26.92% in 2020 (P = .029). Pain scores on POD 1-4 showed no differences (P ≥ .4875). 90-day postdischarge opioid prescriptions decreased in 2020, though not significantly. Fracture location and concomitant gabapentin use were significant predictors of outpatient opioid use (P = .001 and P = .013, respectively.).

A multidisciplinary approach is effective for reducing inpatient opioid consumption in operatively treated upper extremity fracture patients, with the greatest reduction seen on POD 1 and 2. Increases in gabapentin prescriptions following protocol implementation may indicate the beneficial role of gabapentin administration in decreasing inpatient opioid consumption.