Fixation of chest wall injuries may not decrease patient use of narcotic pain medication
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Key takeaways:
- Operative and nonoperative treatment groups had similar narcotic pain medication utilization.
- There were no differences between the groups for generalized pain, chest wall pain or shortness of breath.
SEATTLE — Surgical fixation of unstable, chest wall flail injuries may not decrease patient pain, shortness of breath or use of narcotic pain medication compared with nonoperative treatment, according to data presented here.
“The benefits of chest wall fixation perhaps do not contribute as much as some surgeons believe in terms of pain and lowering the amount of narcotic pain medication utilized,” Niloofar Dehghan, MD, MSc, said in her presentation at the Orthopaedic Trauma Association Annual Meeting.
Dehghan and colleagues performed a secondary analysis of a multicenter, randomized control trial in which 207 patients were randomly assigned to either nonoperative treatment (n = 99) or surgical fixation (n = 108) for acute, unstable chest wall injuries. Outcomes included the amount of daily in-hospital narcotic pain medication utilized, generalized pain, chest wall pain, chest wall tightness and shortness of breath.
Dehghan said researchers found no significant differences regarding in-hospital utilization of narcotics at any timepoint between the groups. In addition, she said a comparison of the groups showed no differences in patients’ chest wall pain, generalized pain or shortness of breath.
“Interestingly, not only did surgery not improve the amount of narcotics needed, it actually increased it,” Dehghan said. “Surgical patients needed more pain medication. However, there was no statistical difference between the groups.”
She also said patients who were intubated required twice as much narcotic pain medication as non-intubated patients.
“[Trauma surgeons] are convinced that surgery makes such a difference for pain and lowering the amount of narcotics administered, but perhaps we are looking at the wrong outcomes. Maybe we should change the outcomes that we are looking at because the present study does not support it,” Dehghan said.
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Dehghan N, et al. Paper 94. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 18-21, 2023; Seattle.
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