Reduction of Opioid Consumption After Outpatient Orthopaedic Trauma Surgeries Using a Multimodal Pain Protocol.

Autor:	Siow MY; From the Department of Orthopaedic Surgery (Siow, Mitchell, Vuong, Zanzucchi, Girard, Schwartz, and Kent), University of California and theDepartment of Anesthesiology (Finneran), University of California, San Diego, CA., Mitchell BC, Vuong CL, Zanzucchi A, Finneran JJ 4th, Girard PJ, Schwartz AK, Kent WT
Jazyk:	angličtina
Zdroj:	The Journal of the American Academy of Orthopaedic Surgeons [J Am Acad Orthop Surg] 2022 Feb 01; Vol. 30 (3), pp. e327-e335.
DOI:	10.5435/JAAOS-D-20-01417
Abstrakt:	Introduction: Because of the dearth of literature in the orthopaedic trauma population, we aimed to analyze how a multimodal pain protocol after outpatient surgery affects opioid consumption, pain scores, and patient satisfaction. Methods: This was a cohort study with a historical control at an urban level 1 trauma center. Forty consecutive outpatients were given a peripheral nerve block and a multimodal pain protocol between September 2019 and March 2020 and compared with 70 consecutive preprotocol patients who received a peripheral nerve block and hydrocodone-acetaminophen. The primary outcome was morphine milligram equivalents (MMEs) consumed. Our secondary aims were pain scores and satisfaction. Results: Patients in the protocol were younger (36.45 versus 45.09 years, P = 0.007), butthere was no difference in sex, body mass index, American Society of Anesthesiologists, or surgical duration. There was a 59% reduction in opioids consumed in the first 4 days after surgery (3.83 MME versus 9.29 MME, P < 0.001). At the postoperative day-14 time point, protocol patients consumed a total of 5.59 MMEs, which is 40% less than just the first 4 days of the preprotocol (P = 0.02). Protocol patients assigned a higher rating of "least pain" on postoperative day 1 (1.24 versus 0.52, P = 0.04) but had higher satisfaction scores on day 1 (9.68 versus 8.54, P < 0.001) and day 2 (9.66 versus 8.61, P < 0.001). Conclusion: Implementation of a multimodal pain management protocol after outpatient orthopaedic trauma surgeries reduced opioid consumption by >50% in the first 4 days postoperatively. Additional studies are needed to refine the multimodal pain protocol used in this study. Level of Evidence: II. (Copyright © 2021 by the American Academy of Orthopaedic Surgeons.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu