Fewer Opioid Pills After Orthopaedic Trauma Surgery Maintain Perceived Pain and Return-To-Work Self-Efficacy

In response to the opioid epidemic, our practice substantially reduced the number of opioid pills prescribed or dispensed to patients after fracture surgery. This study explored patient outcomes under this protocol.

In this survey of 125 adult patients from one level I trauma center combined with retrospective chart review, patients had undergone surgery for distal radius, proximal humerus, femoral neck, tibial shaft, or lateral malleolus fracture (n = 25 patients per location). The pain management protocol reduced the total number of opioid pills dispensed at discharge to 42 (oxycodone 5 mg or hydromorphone 2 mg, taken as needed every 6 hours), advising discontinuation within 3 days. Patients were evaluated at least 3 months postoperatively. Patient-reported outcome measures, cross-referenced with chart data, were assessed using the Pain Self-Efficacy Questionnaire (PSEQ) and the Return-to-Work Self-Efficacy questionnaire and were compared. Pain was assessed using verbal and numeric rating scales.

Median pain scores for all five groups corresponded to mild pain on both rating scales. PSEQ and Return-to-Work Self-Efficacy responses demonstrated high confidence, with median scores at or exceeding 4 on a 0 to 6 Likert scale. Two PSEQ questions regarding the ability to enjoy activities and gradually increase movement despite pain showed notable differences across surgical groups.

Fewer opioid pills effectively managed postoperative pain and aligned with high patient self-efficacy. Consistency between patient-reported outcome measures and medical records supported these findings. These observations are exploratory and should be interpreted in the context of a descriptive design.

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