Does Facial Fracture Management Require Opioids? A Pilot Trial of a Narcotic-Minimizing Analgesia Protocol for Operative Facial Trauma.

Autor:	Knudsen MG; Department of Plastic and Reconstructive Surgery, University Hospitals Cleveland Medical Center-Case Western Reserve University, Cleveland, OH., Kotha VS; Department of Plastic and Reconstructive Surgery, University Hospitals Cleveland Medical Center-Case Western Reserve University, Cleveland, OH., Wee C; Department of Plastic and Reconstructive Surgery, University Hospitals Cleveland Medical Center-Case Western Reserve University, Cleveland, OH., Lesko RP; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD., Swanson M; Department of Plastic and Reconstructive Surgery, University Hospitals Cleveland Medical Center-Case Western Reserve University, Cleveland, OH., Kumar A; Department of Plastic & Reconstructive Surgery, The Mercer University School of Medicine, Savannah, GA., Davidson EH; Department of Plastic and Reconstructive Surgery, University Hospitals Cleveland Medical Center-Case Western Reserve University, Cleveland, OH.
Jazyk:	angličtina
Zdroj:	The Journal of craniofacial surgery [J Craniofac Surg] 2023 Jun 01; Vol. 34 (4), pp. 1199-1202. Date of Electronic Publication: 2023 Jan 30.
DOI:	10.1097/SCS.0000000000009190
Abstrakt:	Opioid minimization in the acute postoperative phase is timely in the era of the opioid epidemic. The authors hypothesize that patients with facial trauma receiving multimodal, narcotic-minimizing pain management in the perioperative period will consume fewer morphine milligram equivalents (MMEs) while maintaining adequate pain control compared with a traditional analgesia protocol. An IRB-approved pilot study evaluating isolated facial trauma patients compared 10 consecutive prospective patients of a narcotic-minimizing pain protocol beginning in August 2020 with a retrospective, chart-reviewed cohort of 10 consecutive patients before protocol implementation. The protocol was comprised of multimodal nonopioid pharmacotherapy given preoperatively (acetaminophen, celecoxib, and pregabalin). Postoperatively, patients received intravenous (IV) ketorolac, scheduled acetaminophen, ibuprofen, and gabapentin. Oxycodone was reserved for severe uncontrolled pain. The control group had no standardized protocol, though opioids were ad libitum. Consumed MMEs and verbal Numeric Rating Scale (vNRS) pain scores (0-10) were prospectively tracked and compared with retrospective data. Descriptive and inferential statistics were run. At all recorded postoperative intervals, narcotic-minimizing subjects consumed significantly fewer MMEs than controls [0-8 h, 21.5 versus 63.5 ( P = 0.002); 8-16 h, 4.9 versus 20.6 ( P = 0.02); 16-24 h, 3.3 versus 13.9 ( P = 0.03); total 29.5 versus 98.0 ( P = 0.003)]. At all recorded postoperative intervals, narcotic-minimizing subjects reported less pain (vNRS) than controls (0-8 h, 7.7 versus 8.1; 8-16 h, 4.4 versus 8.0; 16-24 h 4.3 versus 6.9); significance was achieved at the 8 to 16-hour time point ( P = 0.006). A multimodal, opioid-sparing analgesia protocol significantly reduces opioid use in perioperative facial trauma management without sacrificing satisfactory pain control for patients. Competing Interests: The authors report no conflicts of interest. (Copyright © 2023 by Mutaz B. Habal, MD.)
Databáze:	MEDLINE
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