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Citation
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King SA, Harper C, Smith LM, Crismon D, Heidel RE, Hall G, Beam Z, Daley BJ. Am. Surg. 2022; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Rib fracture (RF) pain management provides analgesia while reducing opioids. We postulated: (1) Prescriber factors affect opiate duration, and (2) lidocaine infusion curtails dependency.
MATERIALS AND METHODS: Retrospective study of RF patients undergoing multimodal analgesia at ACS-verified Level 1 Trauma Center April 2018-February 2020. Exclusions: age<18 y/o, GCS < 14, hospital length of stay (LOS) <3 d, <3 RF, ventilator support, injury-related mortality, disclosed/discoverable, acute/chronic opiate Rx within 90 days preadmission, substance abuse, patient inaccessible via Controlled Substance Monitoring Database (CSMD), and/or not using opioids in-/post-hospitalization. CSMD queried regarding opioid prescriptions filled by cohort. Cohort variable analysis performed on SPSS Version 27sf (Armonk, NY: IBM Corp).
RESULTS: 153 patients included - 113 (74%) stopped opiates by 30 days post-discharge (NORx30), 40 (26%) continued beyond 30 days (Rx+). No significant differences in age, gender, ISS, number of RF, bilaterality, flail chest, and discharge disposition. Significant differences included hospital LOS (7.62 NORx30 vs. 10.22 Rx+, p =.02), number of prescribers (1.73 NORx30 vs. 2.98 Rx+, p <.01), average MME/day during initial 30 days post-discharge (36.7 ± 17 NORx30 vs. 45.4 ± 30.2 Rx+, p =.03), and number of pills (49 ± 38 NORx30 vs. 120 ± 85 Rx+, p <.01). Patients who received lidocaine infusion (LIDO+) had lower MME/day prescribed (32.24 ± 19.9, p =.03), were younger (61.2 vs. 65.6, p <.01), had more RFs (7.1 vs. 6.05, p =.03), and shorter LOS (7.71 vs 10.2, p =.01).
DISCUSSION: Prescriber attention to MME/day and number of pills dispensed affects opioid dependency. We recommend 35-40 MME/day with 50 pill/month limit prescribed by a single provider monitoring patient and CSMD. Early LI offers post-discharge opioid cessation advantage.
Language: en |