Decreasing Postoperative Opioid Prescriptions After Orthopedic Trauma Surgery: The "Lopioid" Protocol.

Abstract

OBJECTIVE:

To assess the effectiveness of a multimodal analgesic regimen containing "safer" opioid and non-narcotic pain medications in decreasing opioid prescriptions after surgical fixation in orthopedic trauma.

DESIGN:

Retrospective cohort study.

SETTING:

One urban, academic medical center.

SUBJECTS:

Patients with traumatic fracture from 2018 (n=848) and 2019 (n=931).

METHODS:

In 2019, our orthopedic trauma division began a standardized protocol of postoperative pain medications that included 50 mg of tramadol four times daily, 15 mg of meloxicam once daily, 200 mg gabapentin twice daily, and 1 g of acetaminophen every 6 hours as needed. This multimodal regimen was dubbed the "Lopioid" protocol. We compared patients who received this protocol with all patients from the prior year who had followed a standard protocol that included Schedule II narcotics.

RESULTS:

Greater mean morphine milligram equivalents were prescribed at discharge from fracture surgery under the standard protocol than under the Lopioid protocol (252.3 vs 150.0; P < 0.001), and there was a difference in the type of opioid medication prescribed (P < 0.001). There was a difference in the number of refills filled for patients discharged with opioids after surgical treatment between the standard and Lopioid cohorts (0.31 vs 0.21; P = 0.002). There were no differences in the types of medication-related complications (P = 0.710) or the need for formal pain management consults (P = 0.199), but patients in the Lopioid cohort had lower pain scores at discharge (2.2 vs 2.7; P = 0.001).

CONCLUSIONS:

The Lopioid protocol was effective in decreasing the amount of Schedule II narcotics prescribed at discharge and the number of opioid refills after orthopedic surgery for fractures.

• Authors: Emma K Landes, Philipp Leucht, Nirmal C Tejwani, Abhishek Ganta, Toni M McLaurin, Thomas R Lyon, Sanjit R Konda, Kenneth A Egol
• Journal: Pain medicine (Malden, Mass.) (Pain Med) Vol. 23 Issue 10 Pg. 1639-1643 (09 30 2022) ISSN: 1526-4637 [Electronic] England
• PMID: 34999901 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected].

Chemical References

• Analgesics
• Analgesics, Opioid
• Morphine Derivatives
• Narcotics
• Acetaminophen
• Tramadol
• Gabapentin
• Meloxicam

Topics

• Acetaminophen (therapeutic use)
• Analgesics (therapeutic use)
• Analgesics, Opioid (therapeutic use)
• Gabapentin (therapeutic use)
• Humans
• Meloxicam (therapeutic use)
• Morphine Derivatives (therapeutic use)
• Narcotics
• Orthopedic Procedures (adverse effects)
• Pain, Postoperative (drug therapy, etiology)
• Prescriptions
• Retrospective Studies
• Tramadol (therapeutic use)