title: Prospective Evaluation of Opioid Consumption After Distal Radius Fracture Repair Surgery.
abstract: Pain management and opioid consumption after distal radius fracture (DRF) open reduction and internal fixation (ORIF) are highly variable and poorly understood. To optimize postoperative opioid dosage and better understand opioid consumption patterns after DRF-ORIF, we conducted a prospective study with the hypothesis that opioid consumption would increase with worsening fracture classification and various patient demographics. All patients who underwent DRF-ORIF were consecutively enrolled over a 6-month period. Information collected included patient demographics, fracture type, anesthesia type, amount and type of opioid prescribed, number of pills taken, reason for stopping, and adverse events. Statistical analysis was performed. Ninety-eight patients (79 female, 19 male) were eligible for the study. Mean age was 58 years. Of the 98 patients, 45 received general anesthesia, and 53 received regional anesthesia with a single-shot peripheral nerve block. Mean opioid consumption (morphine equivalence) over a mean of 4.8 postoperative days (range, 0-16 days) was 58.5 mg (range, 0-280 mg). There were no significant differences in opioid consumption between the general and regional anesthesia groups. Mean opioid consumption for the 3 fracture-type groups (AO/OTA [Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association] classification) was 57.7 mg (class A), 60.3 mg (class B), and 62.0 mg (class C). Demographic analysis revealed an inverse relationship between age and opioid use. Similarly, there was a trend toward more opioid consumption among self-pay and Medicaid patients. Opioid consumption after DRF-ORIF was equivalent for general and regional anesthesia. A significant relationship was found between increasing age and decreasing opioid consumption. Worsening fracture classification and self-payment/Medicaid payment trended toward increasing opioid consumption. Mean overall opioid consumption (morphine equivalence) was 58.5 mg, or 14.6 pills of oxycodone/acetaminophen 5/325 mg. Surgeons should take these findings into account when optimizing opioid prescribing after DRF repair.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: O'Neil
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wang
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.forename: Mitchell
authors.initials: M
authors.lastname: Maltenfort
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, PA. asif.ilyas@ rothmaninstitute.com.
authors.forename: Asif M
authors.initials: AM
authors.lastname: Ilyas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D011884:Radius / Q000601:surgery*; D011885:Radius Fractures / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid