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Pain management protocol reduced narcotic analgesic use in patients after distal radial fracture surgery
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SAN FRANCISCO — Use of a multi-modal pain program reduced the number of narcotic analgesics taken by patients after distal radial fracture surgery, according to a presenter here at the American Society for Surgery of the Hand Annual Meeting.
“Our conclusion is that the pain management protocol that we use effectively controls pain in a prospective study of a moderately painful surgery as measured by the number of hydrocodone taken,” David L. Nelson, MD, said. “I think the protocol can serve as a model upon which other surgeons can design their own pain management protocol that fits their own practice situation. ... Distal radius fractures can be used as an index surgery by which various surgeons can assess the effectiveness of their pain management protocol to others because it is a common surgery, it is moderately painful and we all do it about the same way.”
David L. Nelson
Nelson and colleagues prospectively evaluated 59 patients who underwent open reduction, internal fixation for distal radial fracture surgery with a volar plate. The pain management protocol included preoperative counseling of expected pain, a preoperative long-acting oral acetaminophen and long-acting non-steroidal, a pre-incision lidocaine block and an intraoperative bupivacaine block. Postoperatively, the pain management protocol included prescribing a non-PRN long-acting oral acetaminophen and long-acting non-steroidal for 2 days after surgery followed by PRN, hydrocodone/acetaminophen 5:500 for breakthrough pain, a postoperative telephone call and assessment of the pain management protocol at 10 days post-surgery, according to the abstract.
They found that at 10 days after surgery, the average number of hydrocodone/acetaminophen pills taken was 0.68 pills and no patients asked for a refill. Of the patients in the study, 72% of patients took no opioids because they believed their pain did not require it. Additionally, 8% of patients took one pill, 6% of patients took two pills, 5% of patients took three pills and 3% of patients took five pills, according to the abstract.
Reference:
Nelson DL. Paper #7. Presented at: American Society for Surgery of the Hand Annual Meeting. Oct. 3-5, 2013; San Francisco.
Disclosure: Nelson receives royalties and retains intellectual property rights from Orthofix and is on the speaker’s bureau for AO, International Hand and Wrist Biomechanics Symposium.