Comparison of post-op opioid use and pain between short and long cephalomedullary nails in elderly intertrochanteric fractures.

Autor: Pectol RW; Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA., Kavolus MW; Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA., Kiefer A; Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA., Sneed CR; Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA., Womble T; Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA., Foster JA; Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA. austin.foster@uky.edu., Kinchelow DL; Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA., Hawk GS; Department of Statistics, University of Kentucky, Lexington, KY, USA., Matuszewski PE; Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA., Landy DC; Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA., Aneja A; Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 780 Rose St., MN508, Lexington, KY, 40536, USA.
Jazyk: angličtina
Zdroj: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie [Eur J Orthop Surg Traumatol] 2023 Oct; Vol. 33 (7), pp. 3135-3141. Date of Electronic Publication: 2023 Apr 13.
DOI: 10.1007/s00590-023-03553-7
Abstrakt: Purpose: It remains unknown if cephalomedullary nail (CMN) length has an impact on pain and opioid use following fixation. Given the lack of level I evidence favoring a specific CMN length to prevent adverse surgical outcomes, we investigated if CMN length impacts acute postoperative pain and opioid use. The authors hypothesize that the use of longer CMNs results in increased pain scores and morphine milligram equivalents (MME) intake during the 0-24 h (h) and 24-36 h postoperative period.
Methods: A retrospective chart review was performed from 2010 to 2020 of patients ≥ 65 years-old who underwent CMN for IT fractures and fractures with subtrochanteric extension (STE). We compared patients who received short and long CMNs using numeric rating scale (NRS) pain scores and MME intake at 0-24 h and 24-36 h postoperatively.
Results: 330 patients receiving short (n = 155) and long (n = 175) CMNs met criteria. CMN length was found to not be associated with higher pain scores in the early postoperative phase. However, patients with long CMNs received higher MME from 0-24 h (25.4% estimated mean increase, p value = 0.02) and 24-36 h (22.3% estimated mean increase, p value = 0.04) postoperatively, even after adjusting for covariates, gender, and age.
Conclusion: Patients with long CMNs received greater MME postoperatively. Additionally, differences in pain and MME were not significantly different between patients with and without STE, suggesting our findings were not influenced by this pattern. These results suggest longer CMNs are associated with higher acute postoperative opioid intake among patients with IT fractures.
Level of Evidence: Therapeutic level III.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
Databáze: MEDLINE
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